Exhibitor Application

24th Annual Wisconsin Council on Problem Gambling Conference
March 16-17, 2023, The Osthoff Resort in Elkhart Lake

All Exhibit Applications Must Be Received By February 15, 2023.

Organization Name: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Person(s) responsible for exhibit *

Address (if different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Telephone *

Fax

Email *

The cost per table is $175.00. This includes one 8’ table and registration for one person to accompany your booth and participate in conference workshops and meals during the conference. Pre-conference workshops are an additional cost, listed below Lunch is not included for the pre-conference. Additional persons can attend by completing the registration form found on the conference brochure and paying the applicable conference rate. If the additional person(s) would like meals only it would be an additional $50.00. Space is limited; only 15 exhibitor spaces are available. You will be able to set up any time after 6:00pm on Wednesday, March 15th.

Short descrition of your Exhibit:

One 8' table and registration for one person to accompany your booth and participate in conference workshops and meals during the conference. *

Yes - $ 175.00

Additional Table - $ 125.00
Additional Person, meals only - $ 50.00

Additional Persons Name

First

Last

Do you plan to attend Pre-Conference ( March 15, 2023 ) workshops?

Drum Circles: An Alternative and Holistic Approach to Treatment – James Harrison III (12:30PM-4:30PM – 4 hours) - $ 30.00
Navigating the Future with Clinical Supervision – Andrew J. Schreier (9AM-4PM – 6 hours – 1 hour lunch) - $ 50.00

ETHICS (8:00AM-12:00PM – March 15, 2023) – Dr. Daniel Bishop you MUST check the box to participate - *LIMITED SEATING*

Ethics, Boundaries, and Much More

I need EAP - Continuing Education *

Yes
No

Awards Banquet: Thursday, March 17, 2022, 6:00pm-9:00pm. *

I will be attending
I will not be attending

Additional person will be attending (if selected)

Meals *

Regular
Vegetarian

Additional Persons Meals (if selected)

Regular
Vegetarian

Electricity needed? *

Yes
No

Renew your Bronze or higher Membership or join now and save $35 off Full Conference Registration! *

Yes
No

For your Membership discount, please enter your membership amount minus $35 ( example: Membership of $75 -$35 = $40, enter in $40 )

Payment: How will you be paying? *

Credit Card- Processing fee - $ 3.50
I will mail check or money order to the WCPG, 1585 Allouez Ave, Green Bay, WI 54311. - $ 0.00

Total Due

$ 0.00

Pay by credit card using Paypal (you do not need a Paypal account) or make checks payable to the Wisconsin Council on Problem Gambling (WCPG). Mail payment to: Wisconsin Council on Problem Gambling, Inc. Attn: Conference Coordinator 1585 Allouez Ave. Green Bay, WI 54311

The Wisconsin Council on Problem Gambling, Inc. assumes no liability for damage to exhibits, either in transit to or from the hotel or while the exhibit is in the hotel. The exhibitor assumes all liability for the exhibit. The Council reserves the right to determine the eligibility of all exhibit space and individual products and services to be exhibited. Exhibits which are determined to be inconsistent with the high standards of the Conference or are otherwise noisy, in bad taste, or conflict with the orderly management of the Conference, will be denied admission to the Conference. Signature *

Title/Position

Date *

Name

All Exhibit Applications Must Be Received By February 14, 2022.

Exhibitor Application

24th Annual Wisconsin Council on Problem Gambling ConferenceMarch 16-17, 2023, The Osthoff Resort in Elkhart Lake

24th Annual Wisconsin Council on Problem Gambling Conference
March 16-17, 2023, The Osthoff Resort in Elkhart Lake