Registration Form

Please fill out the form below to complete your registration. If you have any questions, please contact Melissa Dissinger.

* indicates a required field.

1. Exhibitor's Information:
*Company Name (as you want it to appear in the Directory):  
*Contact Person's Name (as you want it to appear in the Directory):  
*Contact Phone Number (as you want it to appear in the Directory):  
*Contact Fax Number (as you want it to appear in the Directory):  
*List of other attendees for Pittsburgh session (if none enter "none"):  
*List of other attendees for Camp Hill session (if none enter "none"):  
*Email address for Directory:  
*Mailing Address:  
*City:  
*State:  
*Zip Code:  
*Main Phone:  
*Contact's Title:  
2. Equipment:

*We will provide tables, chairs, electric and power strips for your booth area - Booth size will be 8’ by 8’. Do you require any additional space?

If so, how much? Or, if you are bringing your own booth/pop-up, let us know.

Wireless access will be provided

  

Yes No

Please describe additional space requirements below:
*What type of equipment are you bringing?  
What type of additional equipment do you require?  
3. Booth/Break-out Session Information:
*What software or technologies are you showcasing at your booth area?  
*Who will be presenting in Pittsburgh?  
*Who will be presenting in Camp Hill?  

*Would you like to have a 50 minute break-out session to talk about a specific software or technology that you currently have within Highmark?

(Highmark will provide LCD projectors for break-out sessions)

  

Yes No

If so, what is the subject or title of your break-out session?

Please provide an abstract on the break-out session (provide a detailed description – this will be included in our Welcome Packet for all attendees):

*Do you require any additional equipment for your break-out session?

(Highmark will provide LCD projectors for break-out sessions)

 

  

Yes No

If so, what equipment will you need?
4. General:
*Would you like to donate a door prize? (We will hold drawings every half hour).   Yes No

What items will you be donating in Pittsburgh?

  

What items will you be donating in Camp Hill?

(NOTE: If you are donating a door prize, please send your company logo to 2007TechFair@highmark.com in .jpg or .gif format – your company logo will be placed in our Welcome Packet as a thank you for donating a prize.)

  
Please list any special requests or needs: