DOWNLOAD/PRINT Event Registration Form

HolisticGLOBE Expo Event Registration Form
This
is NOT an interactive
onlineRegistration
form. Please
PRINT and COMPLETE FORM manually. Signature is required.
HolisticGLOBE
Expo 2015 Events
Form
PLEASE FAX OR EMAIL THIS FORM TO PROCESS YOUR EVENT REGISTRATION and APPROVE charges.
FAX (888) 349-3422 // EMAIL [email protected] // Need Help? Call (561) 325-8640
___First Time Participant
One Event/Local
____ Returning Participant
3+ Event/Regional
12+ Event/National
6+ Event/ Regional PLUS
Other
List Event Location(s) & Date(s)
About You
Individual Name
_______________________________________________________________________
Company Name
_______________________________________________________________________
Street Address
_______________________________________________________________________
City/State/Zip
____________________________ / ___________________
Phone Number
______________________________ Fax Number
Email Address
_______________________________________________________________________
Website
_______________________________________________________________________
X Select Your Options
__ Official Sponsor
__ Sponsor
__ Vendor
__ Keynote Speaker
__ Psychic/ Healer/Massage Therapist
__ Non-Vendor Supporter/Networker
__ Workshop Teacher
__ Musician / Performer
__ Lecture Presenter / Speaker
__ Brand Ambassador / Product Demo
Applicable Discount (Approval Required)
__ Multi-City Booking
__Special Package/Local Promo Offer
__Holistic Authority™ Leadership Society
__Returning Vendor Loyalty Discount
__Non-Profit Organization
__ Early Bird Special
/ _______________
__________________________
__ Diamond $10,000
__ Gold $5,000
__ Silver $2,500
__ Bronze $1,000
__ Premium Exhibit $500
__ Standard Exhibit $300
__ Basic Exhibit (Open Space) $150
__ Electricity/Wi-Fi Access * $ 25
__ Additional Exhibit Table $ 50 each
__Corner Space/ Premium Spots $100
__ HolisticGLOBE Magazine Full Page Display Ad $599
__ HolisticGLOBE Magazine Half Page Display Ad $425
__ HolisticGLOBE Magazine 1/3 Page Display Ad $345
__ HolisticGLOBE Magazine 1/4 Page Display Ad $295
__ HolisticGLOBE (Dedicated Solo eMail) National Blast $750
__ HolisticGLOBE (Dedicated Solo eMail) Regional Blast $500
__ HolisticGLOBE eNewsletter Ad Insertion $300
__ Holistic Globe Radio® Interview or Article $ 150
__ “Meet & Greet” Vendor/Expert Video Feature $100
HolisticGLOBE Expo Event Registration Form
Term & Waivers
 Sponsors/exhibitors are allowed to share/display information and conduct product/services sales,
unless specified not to. No commissions or additional fees will apply to your participation other
than exhibit fees and any advertising and/or add-on you voluntarily selected.
 You and your organization consent to interview(s), photography, audio recording, video
recording and its/their release, publication, exhibition, or reproduction to be used for news, web
casts, promotional purposes, telecasts, advertising, inclusion on web sites, or any other purpose by
Holistic Globe Networks and all its affiliates and representatives. You release Holistic Globe
Networks, its officers and employees, and each and all persons involved from any liability
connected with the taking, recording, digitizing, or publication of interviews, photographs,
computer images, video and/or or sound recordings.
 You waive all rights you may have to any claims for credit, reward, payment or royalties in
connection with any sale, promotion, exhibition, streaming, webcasting, televising, or other
publication of broadcast materials, regardless of the purpose or whether a service or royalty fee is
charged. You also waive any right to inspect or approve any photo, video, or audio recording
taken by Holistic Globe Networks and all its affiliates and representatives, or the person or entity
designated to do so.
 License and Usage: Advertiser/Exhibitor hereby grants HGN a limited, non-exclusive license to use
your trade name, logo, artwork, trademarks, service marks and other proprietary information
owned by the advertiser. HGN agrees that the Proprietary Information will be used only in
connection with the broadcast to provide the benefits set forth in the advertising agreement.
 No-Refund Policy: Exhibit/Sponsorship and Advertising Dues are NON-REFUNDABLE. Event
participation and advertising charges are non-refundable, with the exception of event
cancellation by producer when not providing alternative date/location.
 Transferability Policy: Exhibit Agreement is NOT transferable.
Payment Info & Authorization
___Credit/Debit Card
___Wire Transfer
___ACH/Self-Pay Online PayLink/Invoice ___ Multi-Event Payment Plan
___ Money Order/Cashier’s Check ONLY (SORRY NO CHECKS)
Debit/Credit Card # ________________________________________________ Expiration: _______/_______
Name as it appears on Credit Card: ________________________________________________________
Billing Address for Credit Card: ___________________________________________________________
City: _______________________________
State: _____
Zip Code: ______________________
3 Digit CV Code _____________ (Back) or 4 Digit Code for AmEx (Front) _____________
X
I authorize Holistic Globe to submit electronic invoice and bill credit/debit card provided for the
specified amount. I acknowledge all sponsorship/exhibit and advertising fees charges as non-refundable.
____________________________________
Approval Signature
____________________________________
Today’s Date
____________________________________
Print Name
____________________________________
Your Position/ Authority