1 Appendix C. Sample Forms/Letters. 1. Vendor Registration Form 2. Speakers Information form 3. Independent Contractor Agreement 4. Presiding Officer Information. Have form for each presiding officer. Instruct presiding officer to repeat questions for the group and to maintain time schedule. 5. Pre-Registration Materials (pre-registration packet) 6. Brochure to members 7. Evaluation sheet for exhibitors. Include information about next year s AME, date, location, Chair and Exhibits Chair.
2 COMPANY PADA ANNUAL MEETING & EXHIBITION Vendor Registration Form CONTACT ADDRESS Please list business address that PADA should use for all correspondence throughout the year. TELEPHONE FAX Preferred method of communication: Mail: E- Mail: COMPANY NAME As it will appear on your booth sign PLEASE PRINT CLEARLY Name of Representatives 1) Session Attendee: 2) 3) 4) PRODUCT DESCRIPTION (50 words or less) Registration Prior to date Postmarked by (date) Standard Exhibit Space $475 $525 Premium Exhibit Space $ 25 $ 25 2 Booths $700 $775 Non profits/members $300 $375
3 Electric hook-up $ 75 $ 75 Extra Lunch Meal(s) $ 25 each $ 25 each number: Pipe and Drape _$20 _$20 Late Fee for registrations postmarked after March 19, 2010 $50.00 SPONSORSHIP DONATION (includes a booth): DIAMOND ($ ) GOLD SPONSOR ($ ) SILVER SPONSOR ($ ) _ BRONZE SPONSOR ($800.00) _ Other (specify on page 3) $ Total Exhibit or Sponsorship Check for: $ or Credit Card (MC/Visa or Discover): Pay To: PADA Annual Meeting Exp. date: /_ Signature: VCode: Mail to: PADA Annual Meeting 96 North Woods Blvd. Ste. B Columbus, Ohio Phone: Fax: or AGREEMENT OF TERMS: I agree to the terms in this prospectus for the 2010 PADA Annual Meeting. Signed: Date: Print Name: Phone: Confirmation, Directions, Exhibit Assignments and other information will be sent. Pennsylvania Dietetic Association
4 EARLY BIRD REGISTRATION INVITATION FOR PADA EXHIBITS (year) Dear Prospective Exhibitor/Sponsor: We are pleased to invite you to participate in next year s Annual Pennsylvania Dietetic Association (PADA) meeting and exhibition to be held through, at the located PADA is offering a discounted rate for exhibit space for Early Bird registrations postmarked by. For those vendors who plan to attend but do not take advantage of the early registration offer, registration must be postmarked by, or late fees will apply. The vendor exhibition will be held on, from 11:30 AM to 3:00 PM during which time the PADA will make 11:30 to 1:30 PM unopposed and exclusive in order to provide you with exposure to the attendees. The exhibit fee includes one complimentary full meeting registration, a booth with 6 foot table, wastepaper basket nearby, a brief description of your product/service in the program syllabus, 1 lunch (additional lunches can be purchased for a fee) and booth signage. There will be exhibit activities, including Lunch with the Exhibitors, to encourage attendee participation. In addition to exhibit space, PADA also offers you the opportunity to be spotlighted as a conference sponsor. Being a conference sponsor gives you additional benefits, exposure and recognition of your commitment to our organization. Enclosed for your review are specifics regarding other sponsorship opportunities. Thank you in advance for your support. We look forward to your participation and partnership in another successful annual meeting for the Pennsylvania Dietetic Association. If you have any questions, please feel free to contact: Sincerely, PADA Exhibit & Sponsorship Co-Chairpersons Seize the Opportunity!
5 Be a Sponsor for the 2010 PADA Annual Meeting Diamond Sponsorship Gold Sponsorship $3,000 $2,400 See next page, to specify activity(s) sponsorship See next page to specify activity(s) sponsorship Full page advertisement in the program syllabus 1/2 page advertisement in program syllabus Sponsorship level identified in the exhibit hall Sponsorship level identified in the exhibit hall Premium exhibit space Prime exhibit space Two complimentary meeting registrations for company representative Two complimentary meeting registrations for company representatives Acknowledgement for program support during prime meeting time Acknowledgement for program support
6 Two lunches for company Three lunches for company representatives representatives Silver Sponsorship Bronze Sponsorship $1,200 $800 See next page, to specify activity(s) sponsorship See next page, to specify activity(s) sponsorship 1/4 page ad in the program syllabus Sponsorship level identified Sponsorship level identified in the exhibit hall in the exhibit hall Acknowledgement for program support 50% reduction in registration for one additional company representative Exhibit space on main floor Acknowledgement for program support Two lunches for company representatives Exhibit space on main floor Two lunches for company representatives
7 Sponsorship Opportunities: Please check the activities you wish to sponsor during the meeting: _) Sponsor the Keynote speaker*, (Diamond) Sponsor the continental breakfast (Gold) Sponsor the box lunches (Gold) Sponsor the opening night reception(gold) Sponsor the continental breakfast (Gold) Sponsor two speakers* (Gold) Sponsor one speaker* (Bronze or Silver) Sponsor a refreshment break (s) (3 breaks total), 2 each day (preferred day(s) or (Bronze for one break sponsorship, Silver for two break sponsorships) Each of the above sponsorships will receive: a) Recognition of sponsorship during the sponsored event b) Table to exhibit products/ literature at breakfast, opening night reception or break as sponsored Other Donations: Gift basket/item for PADA Foundation raffle (tax deductible) Item(s): _ Monetary donation to be used as needed, includes recognition of sponsorship Amount: $ _
8 * For more information about these sponsorship opportunities, such as specific speakers please call or
9 Speaker Information Form Please complete and to PADA November 24th: Name/Credentials Title: Company Food Medication Interactions Phone: Fax _ Preferred Mailing Address _ Address: Social Security Number or Tax ID Number (circle one). (To receive payment you must provide a number. If you provide a SSN, the check will be written to you personally and you will be taxed personally. If you provide a Tax ID Number, the check will be written to your company and the company will be taxed.) Sponsor (if applicable) Requested Honorarium/Expenses (if applicable) Session Name Feel free to contact _, Annual Meeting Program Planning Chairman to assure the Session name and Description (below) are in concert with the program theme and objective. Her address is
10 Session Description to be used for the promotional brochure:. Continuing Education Level (see description below) : Level Biographical information to be used for the promotional brochure: Photo attached Photo will arrive by (date). No photo will be provided. _ I plan to have handouts for my session. The handouts will be provided to the ODA office (date) to be included in the Annual Meeting Proceedings Manual PAND will provide the Audio Visuals listed below. Please indicate any audio visual and special needs below. ROOM SET-UP AUDIO VISUALS (Please any audio visual equipment you will need for your presentation) OTHER
11 Session rooms will be set Theater Style with a head table and a podium with a microphone. If you have a different request, let me know and I will make every effort possible to meet your request. Special Needs or Requests: clip on microphone for each speaker. Table Top Lectern Mic Lavaliere/Lapel Mic Lectern Mic Table Mic Floor Mic Flipchart/Easel/Markers Whiteboard/Eraser/Markers Tack Board/Tacks Overhead Projector Stand/Screen Transparency (# needed ) Marking Pens (# needed ) 35mm Slide Projector/Stand/Screen An additional 35mm Slide Carousel There will be an easel at the entrance of the room indicating each session. There will be water on the head table for the speakers near the podium. All Session rooms are non- smoking. Please note, PAND does not provide computers. If you will be using a computer for your presentation, you will need to bring your own lap top. The audio visual company will be able to assist you with connecting it to the data projector. ) of Front Projection Screen (Size: Data Projector - Is the hook up your lap top PC VCR & Monitor (VHS) Laser Pointer Easel INDEPENDENT CONTRACTOR AGREEMENT This Agreement is made and entered into this [DAY] of [MONTH] [YEAR] by and between [AFFILIATE NAME] ( AFFILIATE ACRONYM ) and
12 [NAME] ( Contractor ), pursuant to which Contractor will provide the below described services to [AFFILIATE ACRONYM]. [AFFILIATE ACRONYM] and Contractor hereby agree as follows: 1. Term: Contractor will provide the services described in Paragraph 2 of this Agreement until such time as the work described in Paragraph 2 of this Agreement is completed, or through [DAY AND MONTH], whichever occurs first. In no event shall Contractor provide services under this Agreement beyond [DAY AND MONTH]. Notwithstanding the foregoing, Contractor expressly acknowledges that this Agreement may be sooner terminated pursuant to the provisions of Paragraph 8, below. 2. Services of Contractor: In exchange for the compensation identified in Paragraph 3 hereunder, Contractor will provide the following services to [AFFILIATE ACRONYM]: (a) [Describe what Contractor will do]. (b) The information and data provided in any document delivered to [AFFILIATE ACRONYM] by Contractor shall not contain any false or misleading information and shall be based on credible supporting data and information. 3. Compensation: Compensation by [AFFILIATE ACRONYM] to Contractor will be [$DOLLARS] per hour, to a maximum of [$DOLLARS], plus reimbursement of expenses as defined hereunder. Compensation will be paid in accordance with the following schedule:
13 a) [This section should state how services are to be billed, the procedure to be followed with respect to evaluating and accepting the work and invoice amounts, and when payment will be made.] 4. Reimbursement of Expenses: [AFFILIATE ACRONYM] will reimburse Contractor for necessary and relevant expenses incurred during the term of this Agreement in connection with Contractor s services under this Agreement. Expenses must be related to development of [insert description] and may include [report production expenditures, graphics fees, transportation costs for meetings, and purchase of relevant industry/market studies]. In order to obtain reimbursement for expenses, Contractor must submit receipts for expenditures in excess of $25.00, and expenses totaling more than $ will not be reimbursed if prior written approval for such expenses has not been obtained from [AFFILIATE ACRONYM].
14 5. Independent Contractor: It is understood that Contractor will perform services hereunder as an independent contractor and not as an employee of [AFFILIATE ACRONYM]. Contractor will at all times in the performance of this Agreement remain an independent contractor. Contractor expressly acknowledges that [AFFILIATE ACRONYM] has no obligation to provide any type of insurance or other benefits to Contractor. Contractor is an independent contractor and shall be solely responsible for any unemployment, workers compensation, or disability insurance payments to be made on Contractor s behalf and any social security, income tax, or other withholdings, deductions or payments which may be required by federal, state or local law with respect to any sums paid to Contractor pursuant to this Agreement. Contractor expressly waives any claims against [AFFILIATE ACRONYM] for workers compensation and unemployment insurance benefits. This Agreement does not appoint Contractor as an agent or legal representative of [AFFILIATE ACRONYM] for any purpose whatsoever. Contractor is granted no right or authority under this Agreement to assume or create any obligation or responsibility for or on behalf of [AFFILIATE ACRONYM], or to otherwise bind [AFFILIATE ACRONYM] or to use [AFFILIATE ACRONYM] s name, except with the prior written approval of [AFFILIATE ACRONYM]. 6. Confidentiality: Contractor acknowledges that [AFFILIATE ACRONYM] is placing Contractor in a position of trust and confidence. In particular, [AFFILIATE ACRONYM] and Contractor recognize that to develop high quality work, [AFFILIATE ACRONYM] will need to reveal Confidential Information (as defined below) to Contractor and that Contractor will be provided with or have access to [AFFILIATE ACRONYM] s Confidential Information. While performing services under this Agreement, and after the provision of services under this Agreement ends, Contractor expressly agrees: (i) not to directly or indirectly use any bit of Confidential Information for Contractor s personal benefit, or for the benefit of any entity other than the [AFFILIATE ACRONYM] or any company owned or operated by [AFFILIATE ACRONYM] (and their affiliates); and (ii) not to reveal, divulge, disseminate, disclose, lecture upon, or
15 publish, any bit of Confidential Information without having first obtained written permission from [AFFILIATE ACRONYM]. Contractor will safeguard and maintain secret all Confidential Information and all documents and things that include or embody Confidential Information. After Contractor s provision of services under this Agreement ends for whatever reason, or upon request by [AFFILIATE ACRONYM], Contractor will deliver to [AFFILIATE ACRONYM]all documents, notes, memoranda, correspondence, records, notebooks, and similar repositories of Confidential Information, including all copies thereof and all computer stored information, then in Contractor s possession or under Contractor s control, whether or not prepared by Contractor. Confidential Information means any written or oral information disclosed to Contractor or known by Contractor as a consequence of Contractor s performing Contractor s obligations under this Agreement, which information is not generally known in the industry in which [AFFILIATE ACRONYM] is or may become engaged, and any business, products, processes or services of [AFFILIATE ACRONYM] or any company owned or operated by [AFFILIATE ACRONYM] (and their affiliates), including, but not limited to, any information relating to research, development, inventions, concepts, ideas, designs, techniques, flow charts, products under development, and the documentation thereof. It will be presumed that all information supplied to Contractor for the purpose of Contractor performing Contractor s obligations under this Agreement is Confidential Information. Contractor s obligations shall continue, as to each bit of information, for so long as such information remains Confidential Information. [AFFILIATE ACRONYM] estimates that the value of the Confidential Information will not begin to dissipate for at least five years. 7. Work and Work Product: The Work and all Work Product created by Contractor under this Agreement shall be and remain exclusively the property of [AFFILIATE ACRONYM], and Contractor hereby expressly relinquishes any claim to copyright or ownership of any and all rights, remuneration, or royalties pertaining to, or generated by the publication of the Work or the Work Product. The Work and all Work Product created by Contractor under this Agreement is a work made for hire under the copyright law and [AFFILIATE ACRONYM]
16 may file applications to register copyright in the Work and all of the Work Product as author and copyright owner thereof. If, for any reason, any of the Work or the Work Product is excluded from the definition of a work made for hire under the copyright law, then Contractor, without further consideration from [AFFILIATE ACRONYM], does hereby assign, sell, and convey to [AFFILIATE ACRONYM] the entire right, title, and interests in and to the Work and all of the Work Product, including the copyright therein. Contractor shall execute any documents which [AFFILIATE ACRONYM] deems necessary in connection with the assignment of the Work, all of the Work Product and copyright therein to [AFFILIATE ACRONYM]. Contractor will take whatever steps and do whatever acts [AFFILIATE ACRONYM] requests -- including, but not limited to, placement of [AFFILIATE ACRONYM] s proper copyright notice on the Work and all of the Work Product -- to secure or aid in securing copyright protection in the Work and all of the Work Product and will assist [AFFILIATE ACRONYM] or its nominees in filing applications to register claims of copyright in the Work and all of the Work Product. [AFFILIATE ACRONYM] will reimburse Contractor for Contractor s reasonable expenses in carrying out Contractor s obligations under this Paragraph. [AFFILIATE ACRONYM] shall have free and unlimited access at all times to the Work, the Work Product and all copies thereof, and shall have the right to claim and take possession on demand of the Work, the Work Product and all copies thereof. 8. Assignment, Termination: This Agreement may be assigned by the [AFFILIATE ACRONYM]. This Agreement may not be assigned by Contractor without ADA's prior written consent. In the event of the death or inability of Contractor to carry out Contractor s obligations hereunder, this Agreement shall immediately terminate, and [AFFILIATE ACRONYM] s obligations shall cease upon payment of fees and approved expenses accrued through the date of this Agreement s termination. Either party may cancel this Agreement upon 30 days' written notice to the other party, and it is expressly understood and agreed to by Contractor that the provision of such notice by [AFFILIATE ACRONYM] to Contractor shall in no way obligate [AFFILIATE ACRONYM] to provide Contractor with any compensation whatsoever above and beyond that which is due
17 and owing for services performed and work completed in accordance with the provisions of Paragraphs 2 and 3, above. 9. Entire Agreement: This Agreement contains the entire agreement between Contractor and [AFFILIATE ACRONYM] with respect to the provision of the independent contractor services described herein, and supersedes all prior oral and written agreements, understandings, commitments, and practices between the parties, including all prior employment agreements, whether or not fully performed by the Contractor or [AFFILIATE ACRONYM]. No amendment to or modification of this Agreement shall be effective unless the amendment or modification is reduced to writing and signed by Contractor and [AFFILIATE ACRONYM]. 10. Titles and Headings: The titles and headings contained herein are for convenient reference only and shall not be deemed or construed to be part of this Agreement. 11. Governing Law: This Agreement shall be construed, defined and interpreted under the laws of the State of Illinois, and venue in any judicial proceeding concerning this Agreement shall be in the [STATE AFFILIATE FILES TAXES]. 12. Severability: The provisions of this Agreement shall be severable. The unenforceability or invalidity of any one or more provisions, clauses, or sentences hereof shall not render any other provision, clause of sentence herein contained unenforceable or invalid. The portion of the Agreement which is not invalid or unenforceable shall be considered enforceable and binding on the parties and the invalid or unenforceable provision(s), clause(s), or sentence(s) shall be deemed excised, modified, or restricted to the extent necessary to render the same valid and enforceable, and this Agreement shall be construed as if such invalid or unenforceable provision(s), clause(s), or sentence(s) were omitted, modified, or
18 restricted. The provisions of this Paragraph and Paragraphs 7-8 shall survive the termination of this Agreement for any reason. ACCEPTED AND AGREED TO: Contractor: [NAME] [AFFILIATE Name] Taxpayer ID Number: [ ] By: [NAME], President [AFFILIATE NAME] By: [NAME], Treasurer
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