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 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict 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
