Official use only Accepted Sponsor s Information Company Name: Contact: Address: City/State/Zip: Phone: ( ) Cell: ( ) E-mail: *Please submit logo to Coleen@piaoflouisiana.com no later than June 7th, as we may use it for convention signage or promotional items. Sponsorship Opportunities (available opportunities in black) Convention Program... $ 1,000 Registration Packets... $ 1,000 Name Badges... $ 1,500 Pocket Agendas... $ 500 Convention Ditty Bag... $ 1,500 Hotel Room Keys... Company Expense + $ 500 Welcome Gift... $ 1,500 Agent Exhibit Prize Card...$ 500 First Timers Information Packet...$ 1,000 Convention Wi-Fi Co-Sponsors...$ 1,000 Gathering Room Co-Sponsors... $500 Charging Station... $1,000 Saturday, July 20 Registration Refreshments... $ 500 Board of Directors Lunch... $ 500 Board of Directors Meeting... $ 500 CE Seminar..$ 1,000 CE Coffee Break... $ 500 Education Audio Visual... $ 500 Opening Dinner Reception W/ Exhibitors Co-Sp $ 1,000 Opening Reception Beer & Soda Co-Sp. $ 500 Teen Meet & Greet Co-Sponsors... $ 500 Sunday, July 21 Registration Refreshments... $ 500 Morning CE Seminar... $ 1,000 Morning CE Coffee Break... $ 500 Morning Education Audio Visual... $ 500 General Session Co-Sponsor... $ 1,000 General Session Break Co-Sponsors... $ 1,000 General Session Audio Visual... $ 500 Business Lunch w/ Exhibitors Co-Sponsors $ 1,000 Business Lunch Refreshments Co-Sp.$ 500 Payment Information 2019 ANNUAL CONVENTION SPONSORSHIP APPLICATION Sunday, July 21 (continued) Afternoon CE Seminar... $ 1,000 Afternoon CE Coffee Break... $ 500 Afternoon Education Audio Visual... $ 500 President s Reception... $ 1,700 Monday, July 22 Fun Run... $ 1,000 Fun Run Refreshments... $ 500 Spouses Social Co-Sponsors... $ 1,000 CE Seminar... $ 1,000 CE Coffee Break... $ 500 Education Audio Visual... $ 500 YIPs Board Meeting... $ 500 YIPs Board Breakfast... $ 500 Past Presidents Lunch... $ 1,000 YIPs Pool Party Co-Sponsor... $ 1,000 Family Event Dinner Co-Sponsors... $ 1,000 Family Event Refreshments Co-Sponsors.. $ 500 Family Event Activity Co-Sponsors... $ 500 Dance Party Co-Sponsors... $ 1,000 Dance Party Entertainment Co-Sponsors... $ 1,000 Dance Party Decorations... $ 500 Dance Party Refreshments Co-Sponsor. $ 500 General Sponsorships General Sponsor... $300 ADD ON SPONSORSHIP OPPORTUNITIES ** Must be purchased in conjunction with a Sponsorship OF $500 or more** Convention T-Shirt Co-Sponsors... $250 Ditty Bag Inserts... $100 See Pg. 2 for Add On form and instructions. ***Keystone Club YES, I would like to be a KEYSTONE SPONSOR with my contribution of $1,000 or more. *Please indicate which event you would like to sponsor above. (Incl: 1 free delegate registration {Not to be used in conjunction with the partner benefit}, special recognition in the convention program and banner on display at convention.) Sponsor Commitment Amount: Bill for Amount: OR Amount Enclosed: Payment Type: Check Credit Card Card Type Card Number Exp. Date Code Billing Address: City, State Zip Approval Signature: Date: Return with payment to: PIA of Louisiana 4021 W.E. Heck Ct., Bldg. K Baton Rouge, LA 70816 Fax: (225) 766-1601 Questions? Call (800) 349-3434 or email coleen@piaoflouisiana.com Rev 11-1-18
ONLY those companies who return this completed Add On Sponsorship Form will have this opportunity! The T-Shirts and Ditty Bags will be given to ALL AGENTS registered for PIA of Louisiana s 76th Annual Convention. My company will be a Convention T-Shirt Sponsor for $250.00 DEADLINE IS JUNE 28th SPACE IS LIMITED - REGISTER EARLY! *Please submit logo to Coleen@piaoflouisiana.com. **All logos will be printed in PIA s color scheme** My company will provide Ditty Bag inserts for $100.00 DEADLINE TO HAVE ITEMS ARRIVE IN THE PIA OFFICE IS JULY 3rd Please describe your item *150 Items are required *Items must be small in nature and able to fit inside the average tote bag. Company Name: Contact: Address: City/State/Zip: Phone: ( ) E-mail: Total Amount Included: Payment Information: Visa MasterCard AMEX Check Enclosed Card No. Expiration Date: Sec. Code: Name on Card: Billing Address: City, State: Zip Code: _ Return with payment to: PIA of Louisiana 4021 WE Heck Court, Building K Baton Rouge, LA 70816 Questions? Call (800) 349-3434 or email Coleen@piaoflouisiana.com
Official use only Accepted Exhibitor s Information Company Name: Contact: Address: City/State/Zip: Phone: ( ) Fax: ( ) E-mail: PIA of Louisiana Member Exhibitor $400 OR Non-Member Exhibitor $600 Booth Worker: Email Booth Worker: Email Each Company Representative working the booth MUST also fill out a convention registration form. Exhibiting Specifications Payment Information 2019 ANNUAL CONVENTION EXHIBIT BOOTH REQUEST Exhibiting package includes: One 6ft skirted table or 8ft freestanding area Listing in convention program and communications 2 chairs Entrance for 2 reps to work booth on Saturday & Sunday Shipping: Grand Hotel, Marriott Resort; One Grand Blvd. Point Clear, AL 36564-0639. C/O PIA of LA Convention Exhibit Hall with your company name, name of company representative staying at the hotel and number of boxes. For rates and fees please see the hotel service order form provided. Booth numbers are not needed. Company names are used to deliver packages to your exhibit table. Please arrange to have packages arrive by Friday, July 19th so the warehouse is open to receive them. Electricity/Internet: If your booth requires electricity or internet connection, please submit requests to the Hotel directly using the service order form provided. Cancellation Policy: Written cancellations received on or before June 28, 2019 will be accepted and a refund of 50% of the full payment will be made. Cancellations received after June 28, 2019 will be accepted with no refund of any payment. Please fill out the information below pertaining to your booth preference: Your booth format: 6ft Table Freestanding open space (no table) Booth assignments: will be made by request, using booth size and vendor type considerations. Therefore firm assignments will be made approximately 1 week prior to convention. Exact layout may change due to available space and booth sizes. Booth location will be given out on site when the company representative checks in. Schedule of Events Please Note New Exhibit Days Saturday, July 20, 2019 5:00 pm 6:30 pm Exhibit Set-Up 7:00 pm 9:00 pm Opening Reception w/ Exhibitors Sunday, July 21, 2019 12:00 pm 1:30 pm Exhibit Hall Lunch 1:30 pm 2:00 pm Exhibitor Prize Drawings 2:00 pm Exhibits Tear Down Should you choose to give away a prize at your booth, we will host the prize drawings on Sunday Afternoon. Draw your prize winner(s) by Sunday at 1 pm to have the winner announced. Winners will collect their prize(s) from your booth. This will be the only time where you can publicly give out your door prizes. PIA will not be accepting remaining prizes to be given to winners at a later date, so we encourage companies to require winners to be present! Exhibitor Commitment : Bill for Amount: OR Amount Enclosed: Payment Type Check Credit Card Card Type Card Number Exp. Date Sec. Code Billing Address City, State Billing Zip Approval Signature: Date: Return with payment to: PIA of Louisiana, Inc. 4021 W.E. Heck Ct., Bldg. K Baton Rouge, LA 70816 Fax: (225) 766-1601 Questions? Call (800) 349-3434 or email coleen@piaoflouisiana.com Rev 11/1/18
2019 ANNUAL CONVENTION REGISTRATION Deadline for Early Bird Registration is June 14, 2019 Return this form to: PIA of Louisiana 4021 WE Heck Ct, Building K Baton Rouge, LA 70816 Fax: (225) 766-1601 You may also email your registration to Coleen@piaoflouisiana.com ATTENDEE INFORMATION Mr. Ms.: Preferred First Name: Designations: Agency/Company Name: Address: Suite City/State/Zip: E-mail: Phone: Cell: I AM AN Agent Company Representative Is this your first PIA Convention? Yes No Spouse/Guest: Preferred First Name: Spouse/Guest Email: Spouse/Guest Phone Number Child: Age: Child: Age: Child: Age: Child: Age: Child: Age: Child: Age: Special Requests/Dietary Needs: **Please see detailed registration information on page 2 prior to completing the below sections of the registration form** CONVENTION REGISTRATION 1a. AGENT PIA Member Non Member Agent Only Convention T-Shirt: SM M L XL 2XL (1 convention T-shirt is included with each Full AGENT Registration, additional T-shirts may be purchased below) 1b. COMPANY REPRESENTATIVE With sponsorship or booth Without sponsorship or booth Booth Worker Only (EXPO ADMITTANCE ONLY) 2. PIA GUESTS Spouse/Guest PAYMENT SECTION: Cancellations received in writing by PIA s office by 6/28/19 will receive full refund. No refunds will be made after 6/28/19 due to hotel food and beverage guarantees. Only ONE discount can be applied per agent. SECTION 1 SUBTOTAL: $ SECTION 2 SUBTOTAL: $ SECTION 3 SUBTOTAL: $ SECTION 4 SUBTOTAL: $ I AM A PIA PARTNER I AM A KEYSTONE SPONSOR Visa MasterCard AMEX Bill me on 6/5/19 Check Payable to PIA of LA By 6/14/19 After 6/14/19 3. CHILDREN Family Child (17 & under) Non Family Child $50 $50 4. OPTIONAL ACTIVITIES & EXTRA EVENT TICKETS Additional Convention T-Shirt: SM M L XL 2XL FUN RUN T-Shirt: SM M L XL 2XL Exhibit Hall Pass Only Saturday s Welcome Expo & Sunday s Agent Business Lunch Expo Sunday Events General Session, CE Seminars and President s Awards Reception Monday Events CE Seminar, YIP Adult Pool Party, Family Event, & Adult Dance Party Name of ticket only guests (for name badges): AGENT FIRST TIMER DISCOUNT (full registration only): $ 50.00 ADDITIONAL AGENT FIRST TIMER DISCOUNT (full registration only): $ 100.00 REGISTRATION GRAND TOTAL: $ Rec d Date: Pymt Method: Amount Paid: Balance Due: Conf. Sent: Page 1 of 2 Sponsor: Exhibit: Partner: Member: Other: Rev 1-24-2019 $250 $300 $250 $400 NO CHARGE $325 $375 $325 $475 # X $200 # x $ 15 = # x $ 15 = # x $100 = # x $150 = # x $150 = Card No Expiration Date: Sec. Code: Name on Card: Billing Address: City, State: Zip Code:
Page 2 of 2 Important Registration Details Agents: PIA Member Agent and Non-Member Agent registrations include access to all convention programs, meals, CE sessions, exhibit hall, and social events. Excludes Fun Run (this can be found in the optional activities section). Each fully registered Agent will receive one complimentary Convention T-Shirt. Additional convention T-Shirts can be purchased in the Extra Activities/Tickets section if desired. Agent First Timer Discount can be applied to any primary agent that is attending the convention for the first time and purchasing a Full Registration. (status to be verified by PIA staff). Additional Agent First Timer Discount can be applied to the second and subsequent agents from your agency that are attending the convention for the first time and purchasing a Full Registration. (status to be verified by PIA staff). Company Representatives: Rep With Sponsorship or Exhibit Booth is for those company personnel whose company is exhibiting or sponsoring a PIA Convention event. The registration includes access to all convention programs, meals, CE sessions, exhibit hall and social events. Excludes Fun Run (this can be found in the optional activities section). Rep With-Out Sponsorship or Exhibit Booth is for those company personnel whose company IS NOT exhibiting or sponsoring a PIA Convention event. The registration includes access to all convention programs, meals, CE sessions, exhibit hall and social events. Excludes Fun Run (this can be found in the optional activities section). Booth Worker Only registration is for the Company Rep who will ONLY work their exhibit booth and NOT attend any other convention activities. If you plan to attend other convention events, please select the Full Company Rep Registration or purchase the additional tickets required for those events. These can be found in the event tickets section. Limit 2 Booth Workers per company. If your company will have more than two representatives working the exhibit booth the additional representatives must purchase an expo pass in conjunction with this registration type. PIA Guests: Spouse/Guest Registration is intended strictly for spouses/guests and not other agent or company delegates. It includes all convention events except Continuing Education. It also includes the spouses program. *Please note that invitations for the spouses program will be sent to the email address listed for the spouse/guest on the form. Child Registration includes access to all convention programs, meals, and social events, excluding CE seminars and adult only events. This is complimentary for the children of fully registered delegates. Children who are attending, but are not part of your immediate family, will be required to register as a non-family child for a nominal fee. **Any child 18 and over MUST register as a guest or purchase individual tickets in order to attend PIA convention events. Optional Activities & Event Tickets: Fun Run each Fun Run registration includes ONE shirt, additional shirts are $15.00 each. Shirts come in adult sizes only. The deadline to order Fun Run shirts is June 28, 2019. Convention T-Shirts are available for purchase for $15.00 each. Shirts come in adult sizes only. (Fully registered Agents will receive 1 complimentary shirt). The deadline to order Convention T-Shirts is June 28, 2019. The below tickets must be purchased in conjunction with a full registration. Exhibit Hall Passes are available for those who are NOT purchasing a full registration. It allows access into the exhibit hall only on Saturday evening and Sunday lunch. Sunday Event Tickets are available for anyone that does NOT purchase a full registration. It allows access into the General Session, CE Seminars (agents) and the Presidents Reception & Awards Ceremony. Monday Event Tickets are available for anyone that does NOT purchase a full registration. It allows access into the CE Seminars (agents), YIP Adult Pool Party, Family Event and the Adult Dance Party. Please call the PIA office at 1-800-349-3434 if you need further information regarding your PIA Convention Registration. Hotel Information Please visit the PIA Convention page on PIA s website, www.piaoflouisiana.com for details on the hotel options for the 2019 Convention. Please call the PIA office at 1-800-349-3434 if you need further information regarding PIA Convention Hotel Information.