Complete this form to register as an exhibitor at the 2022 WA ChiroConfab! Please enable JavaScript in your browser to complete this form.Exhibitor Business Name *Exhibitor Membership Level *SilverGoldPlatinumLeadershipPlease select your WSCA corporate membership level.Contact Email *EmailConfirm EmailPrimary Exhibitor Registrant *FirstLastSecond Exhibitor Registrant (optional)FirstLastThird Exhibitor Registrant (optional)FirstLastFourth Exhibitor Registrant (optional)FirstLastPhone *Mailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWebsite / URLCompany LogoPlease select how many locations you want to exhibit at *1 location - $400.002 locations - $500.003 locations - $600.004 locations - $700.00Please select how many locations you want to exhibit at *1 location - $300.002 locations - $375.003 locations - $400.004 locations - $525.00Please select how many locations you want to exhibit at *1 location - $200.002 locations - $250.003 locations - $300.004 locations - $350.00Please select how many locations you want to exhibit at *1 location - $0.002 locations - $100.003 locations - $175.004 locations - $250.00Please indicate which location(s) *ChiroConfab East (Spokane), Oct. 13ChiroConfab South (Vancouver), Oct. 15ChiroConfab North (Bellingham), Oct. 20ChiroConfab West (Auburn), Oct. 22Additional Video Time1 minute - $100.002 minutes - $150.003 minutes - $200.004 minutes - $250.00Each exhibitor may provide video to be included in the Exhibitor CE video (worth 1 CE to attendees). Leadership = 4 min.; Platinum = 3 min.; Gold = 2 min.; Silver = 1 min. If that is not enough, you can more time to your segment of the video by purchasing one of these options. Submit
