CSUN’s 20th Annual International Conference,
"Technology and Persons with Disabilities"

Conference Days: March 14-19, 2005
Exhibition Days: March 16-19, 2005

Company Name: ___________________________
Address: _________________________________
City: _____________________________________
State/Province: ____________________________
Zip/Postal Code: ___________________________
Country:__________________________________
Phone: ___________________________________
FAX: _____________________________________
Company Email: ___________________________
Website: _________________________________


EXHIBIT CONTACT
(Responsible for fees, services, and set up of exhibit space)

Name:_________________________________________________
Email: _________________________________________________

Will the Exhibit Contact be attending the Conference? _____Yes _____ No


I would like to apply for the following:
(please check all that apply)

1. ___ EXHIBIT SPACE:

• Per 8' x 10' Exhibit Space ("Booth"):
  ___ Price: $1795
  20% deposit to hold exhibit space: $359 per booth
  
• Per 16' x 20' Exhibit Space, Island Configuration ("Island"):
  ___ Price: $7795
  20% deposit to hold island: $1559 per island
  
  (In all cases, final payment must be received or postmarked on or before October 15, 2004. No deposits will be accepted after October 15, 2004 ~ full payment is required to secure exhibit space) 

2. ___ ADVERTISING in the Conference Program. 
Camera-ready artwork due January 7, 2005 

• ___Full Page (7 1/2" x 10"): $575 
• ___Half Page (7 1/2" x 4 1/2"): $365 
• ___Quarter Page (3 1/2" x 4 1/2"): $195 

3. ___ LITERATURE DISTRIBUTION
$550 per item. 
Provide 2,500 pieces no later than February 11, 2005 
(International shipments - no later than January 21, 2005). 
Please DO NOT include payment with the literature. 
Mail payment in a separate envelope.

4. ___ CALL FOR PAPERS
Please send information on making a presentation at CSUN 2005. 
There is no charge for this information. 

TOTAL PAYMENT $_______________________________

METHOD OF PAYMENT
___Check enclosed for: $ _________
(Make payable in U.S. Dollars to: CSUN)

___Charge to:  ___VISA  ___MasterCard  ___American Express 

Name of Credit Card Holder: ____________________________________________
Card #: ____________________________________
Exp. Date: ____________________________

EXHIBIT SPACE PREFERENCE
Please list exhibit space(s) in order of preference. List ALL exhibit spaces you would like, should they become available. 

Total # exhibit spaces(s): _______Booth(s) OR _______ Island(s)

List preferences here:

1. ________________
2. ________________
3. ________________
4. ________________
5. ________________
6. ________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Product Category (Please choose one):

___ Agencies/Services
___ Educational/Software
___ Alternative Input/Keyboard Devices
___ Environmental Control Units (Electronic Aids to Daily Living)
___ Augmentative And Alternative Communication (AAC)
___ Learning Disabilities
___ Assistive Mobility Services
___ Telecommunications Devices
___ Blind/Low Vision
___ Other __________________________________________________


Please reserve exhibit space at the CSUN's March 14-19, 2005 Conference (Exhibition Days: March 16-19, 2005) I/We agree to abide by all rules and regulations. I/We understand that after June 30, 2004, and through January 30, 2005, there will be a $100 fee on all cancellations. I/We understand that after January 30, 2005, there will be no refunds on any cancellations.

Authorized Signature: ____________________________________ Date:_________________

Please send completed form and payment to:

Exhibits Coordinator
Center on Disabilities - California State University, Northridge
18111 Nordhoff Street, Building 11 - Suite 103
Northridge, CA 91330-8340
Phone: 818.677.2578 V/TTY
FAX: 818.677.4929
Email: joanne.moreno@csun.edu 
Website: www.csun.edu/cod 


FOR OFFICE USE ONLY

Total payment $_____________________ 
Total Enclosed $ ___________________ 
Check #_____________________________ 
CC #________________________________ 
Date Received ______________________ 
Balance Due ________________________ 
Exhibit Space # ____________________ 
Entered By: ________________________