Register online today at www.wmgma.org

Wisconsin Speech-Language Pathology and Audiology Association 563 Carter Court, Suite B Kimberly WI 54136

REGISTRATION FORM

CONTACT INFORMATION (to receive confirmation)

Name: __________________________________________________________________________________

Address: ________________________________________________________________________________

Phone: __________________________ Email: __________________________________________________

COMPANY INFORMATION

Company Name: __________________________________________________________________________

Company Web Address: __________________________________ Company Phone: ____________________

BOOTH INFORMATION

Companies to Avoid: _______________________________________________________________________ While WSHA tries their best to adhere to requests, we cannot guarantee preferred placement.

SALES REPRESENTATIVES Exhibitor registration includes registration for up to two staff. List name(s) as you would like them to appear on name badges. Exhibitors may

purchase additional badges for $50 each. Please see “Additional Registration Badges” for this option.

Rep 1: _______________________________________ Rep 2: _______________________________________

ADDITIONAL REGISTRATION BADGES:

Exhibitor Badges ______ x $50 = __________________

List name(s) for additional staff as you would like them to appear on name badges.

Name: __________________________________________________________________________________

Name: __________________________________________________________________________________

SPONSOR PACKAGE *Includes exhibit display.

Platinum Sponsor* $2,500

Gold Sponsor* $1,500

EXHIBIT REGISTRATION

$300-WSHA Corporate Member

$500-Non Member Exhibit Table

$50-Electricity

Do you plan on attending the Pontoon Cruise on Elkhart Lake?

Yes *see below

No

*If yes, please add $10 onto your registration total. Refunds will not be provided if weather prohibits the activity.

Total Payment: $____________________________

Do you plan on attending the Annual Golf outing at Quit Qui Oc Golf Club?

Yes

No

METHOD OF PAYMENT WSHA’s Tax ID number is 20-3149613.

Total Enclosed: $ ________ Check (payable of WSHA) Check #_____ VISA MasterCard Discover AmEx

Card Number: _______________________________________ Exp Date: ____ / ____ Security Code: ________

Address on Billing Statement: _________________________________________________________________

Name on Card: _______________________________ Signature: ____________________________________

Please return registration form and payment to: WSHA Office, 563 Carter Court, Suite B, Kimberly, WI 54136 Fax: 920-882-3655 Email: WSHA@badgerbay.co (not .com)

Join WSHA at the 2019 Audiology Update in Elkhart Lake, Wisconsin this Fall!

CONFERENCE SCHEDULE Schedule subject to change.

THURSDAY, SEPTEMBER 19

10:00 a.m. Golf Outing Additional registration required.

5:30-7:30 p.m. Pontoon Cruise on Elkhart Lake Additional registration and cost required.

FRIDAY, SEPTEMBER 20 Friday activities taking place at the Osthoff Resort.

7:30-8:30 a.m. Registration and Breakfast with Exhibitors

8:30-10:15 a.m. A Gerontological Approach to Hearing Care: Lessons from Public HealthCarrie Nieman, MD, MPH

10:15-10:45 a.m. View Exhibits

10:45 a.m.-12:00 p.m.CONTINUED - Innovations in Community-Delivered Hearing CareCarrie Nieman, MD, MPH

12:00-1:00 p.m. Lunch with Exhibitors

1:00-2:00 p.m. Wisconsin Audiology Update Amy Kroll, AuD, CCC-A

2:00-2:15 p.m. View Exhibits

2:15-3:15 p.m. Interpersonal Audiology: Essential Communication Skills in the Era of Consumer-Driven Innovations in Hearing Brian Taylor, AuD

3:15-3:30 p.m. View Exhibits

3:30-4:30 p.m. CONTINUED - Interpersonal Audiology: Essential Communication Skills in the Era of Consumer-Driven Innovations in Hearing Brian Taylor, AuD

4:30 p.m. Adjourn

GENERAL INFORMATION

Exhibit Set Up & Dismantle Set Up: Thursday, September 19 from 3:30-4:30 p.m. Dismantle: Friday, September 20 after 3:30 p.m. Exhibits may not be dismantled before this time.

Additional Needs If your display needs additional equipment or special set-up assistance, please contact the WSHA office at 920-560-5642 or email us at WSHA@badgerbay.co (not .com).

Shipping Materials

If you have packages that need to be shipped to the meeting location, you may do so directly to the Osthoff Resort at this address:

The Osthoff Resort WSHA Fall Audiology/Jason Schnicke 101 Osthoff Ave, Elkhart Lake, WI 53020

The phone number for The Osthoff Resort is 888-385-4562. Shipments should be clearly marked. Please indicate that your packages are for the WSHA Audiology Update and provide your organization’s name. Shipments will not be accepted earlier than THREE working days prior to your arrival date. Handling fees may apply and are the responsibility of the exhibitor.

Lodging

The Osthoff Resort Rate: $169.00/night Phone number: 1-800-876-3399 Reservation deadline: August 22, 2019

When making your reservation, tell the reservation agent that you are booking a room under WSHA-WI Speech-Language Pathology and Audiology Association.

You can also book your room online by navigating to the Osthoff Resort’s website (www.osthoff.com) and clicking on the “Meetings” tab at the top of the page. Once you access this page, please scroll down and click on “To make your individual group reservation, click here.” Please use the following information to book your room online:

Group ID: GWSHA Password: SPEECH

Golf Outing

Thursday, September 19 Quit Qui Oc Golf Club 500 Quit Qui Oc Lane, Elkhart Lake, Wisconsin 53020

Tee times will start at 10:00 a.m. on Thursday, September 19. Please contact the WSHA office at 920-560-5642 or WSHA@badgerbay.co (not .com) if you are interested in playing or indicate your participation on your registration form online. Payment for golf should be made directly to the course the day of the outing.

SPONSORSHIP LEVELS

Platinum Sponsor-Overall Event Sponsor

2 spots available at $2,500, all “exhibitor” benefits included.

• Introduce our opening or closing Speaker, • Option to place promotional items (no literature) for your company for

each attendee in the session room, • Standard 8ft. skirted exhibit table, • Company listing in Audiology Update program, • Name badges with sponsor recognition ribbons, • Introduction of representatives at Audiology Update and inclusion in the

sponsor/exhibitor slide show, • Recognition on the WSHA website with link to your company website, • And complimentary WSHA Corporate Membership (July 2019-June 2020).

Gold Sponsor-Meal Sponsor

2 spots available at $1,500, all “exhibitor” benefits included.

• Welcome attendees to lunch on Friday, September 20, • Option to place promotional items (no literature) for your company in

session room for each attendee, • Standard 8ft. skirted exhibit table, • Company listing in Audiology Update program, • Introduction of representatives at Audiology Update & inclusion in the

sponsor/exhibitor slide show, • Company recognition on WSHA Website, • And complimentary WSHA corporate membership (July 2019-June 2020).

Exhibit Display

$300 WSHA Corporate Members/ $500 Non-Corporate Members

Exhibit Displays Include: • Skirted table, two chairs and table sign with your company’s name, • Two representatives allowed per space. If more than two representatives

wish to attend, additional badges may be purchased, • Non-competitive exhibit viewing times, • Roster of attendees distributed at the time of the Audiology Update, • And complimentary meals and refreshments during exhibit hours.

REGISTRATION INFORMATION

Registration Deadline Register by August 22, 2019 to ensure your company will be recognized in printed materials. Registrations received after August 22 are not guaranteed to be included in onsite materials.

Cancellation Policy Cancellations must be made by August 22, 2019 to the WSHA office at WSHA@badgerbay.co (not .com) or faxed to 920-882-3655. All cancellations will be subject to a $50 cancellation fee. No refunds will be given after August 22, 2019.