Application for Proposed Conference Site

Please provide the following contact information:

Name
Title
Organization
Work Phone
Home Phone
FAX
E-mail

Enter your proposed conference site city and state in the space provided below.

Are there hotels that can hold a conference for up to 200 people?

Yes No

Enter your the name and location of the airport attendees would use in the space provided below.

Enter airlines that fly into the above airport in the space provided below.

Enter the approximate cost of ground transportation between the airport and proposed potential conference hotels in the space provided below.

Please list the names, topics, and cost of speakers you could potentially recommend. Use an attachment if needed.

Do you have a sponsor for copying conference materials for handouts? If yes, who?

Do you have a sponsor to provide conference bags/backpacks? If yes, who?

Do you have facilities who will donate items to give away?

Do you have volunteers for assistance on-site: set-up, assemble conference packets, registration, ticket-takers, room monitors, etc.?

Can you help promote the conference to health unit coordinators in your area facilities and schools? If yes, how?

Enter the restaurants and shops located within walking distance of the proposed conference site in the space provided below.

What off-site attractions do you recommend? Include transportation and admission costs if applicable.  Use an attachment if needed.