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Sponsor and Exhibitor Commitment Form
Tara Landry
2025-03-24T14:21:08-04:00
Sponsor and Exhibitor Commitment Form
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INTERNAL - REGISTRATION STATUS (Does not account for Payment Status)
REGISTRATION COMPLETE
REGISTRATION CANCELLED
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INTERNAL - PAYMENT STATUS
PAID
AMOUNT OUTSTANDING
FREE
FULL REFUND
PARTIAL REFUND
NO REFUND
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INTERNAL - AMOUNT REFUNDED
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INTERNAL - PAYMENT CONFIRMATION NUMBER / CHEQUE NUMBER
Company Name
Name
(Required)
First
Last
Email
(Required)
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
Company Website
Product Name
Premier Partner ($50,000)
Platinum Partner ($25,000)
Gold Partner ($15,000)
Silver Partner ($10,000)
Bronze Partner ($5,000)
Supporter Partner ($3,000)
À La Carte Only (see below)
Yes, I would like to add À La Carte options below
À La Carte Sponsorship Opportunities
Social Event Sponsor
Poster and Exhibit Hall Opening Event Sponsor
Wi-Fi Sponsor
Breakfast Sponsor
Lunch Sponsor
Refreshment Break Sponsor
Conference Bag Sponsorship
Audio Visual Sponsors
Program Advertising Rates
Full Page ($1,500)
Half Page ($1,000)
Quarter Page ($600)
Business card ($300)
None
Early Bird Exhibitor Opportunities
For profit exhibitors ($2,500)
Non-profit exhibitors ($800)
None
Early Bird pricing available until May 15, 2025. Pricing will then increase to $2800 for profit and $950 for non-profit.
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Standard Exhibitor Opportunities
For profit exhibitors ($2,500)
Non-profit exhibitors ($800)
None
Early Bird pricing available until May 15, 2025. Pricing will then increase to $2800 for profit and $950 for non-profit.
Extra Exhibitor Passes
Quantity
Price:
$ 100.00 CAD
Quantity
Full Conference Passes
As an exhibitor, you will receive a $100 discount on full conference passes upon registration.
Full Conference Pass Discount
As an exhibitor, you are entitled to a $100 discount on full conference passes. Please check here if you would like to receive a discount code. Registration for the conference will open mid-April and the discount code can be used at time of registration.
Yes, I would like a $100 discount on full conference passes.
Agreement
(Required)
I have the authority to bind my company to purchase the indicated services. I agree to the terms and conditions and will comply with all policies contained in the Sponsorship and Exhibitor Prospectus.
I agree.
Please upload your logo
Max. file size: 128 MB.
Total
Payment Options
Please select preferred payment method . . .
Credit Card (processed by PayPal)
Cheque
Email Transfer
Payment Method
PayPal Checkout
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Security Code
Cardholder Name
To pay by cheque please make the cheque out to
Canadian Hospice Palliative Care Association
and mail to:
M332 – 1554 Carling Ave, Ottawa, ON K1Z 7M4
To email us a transfer please send to:
[email protected]
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