(HT) Facilities 2014 Applications - 01/15/14

**Exhibit Spaces are VERY Limited!** **Deadline for returning Exhibitor Application: January 15, 2014** PLEASE FAX COMPLETED FORM TO BASA at 614-846-4081 2014 BASA School Facilities Conference Exhibitor Application March 12 & 13, 2014 Doubletree Hotel-Worthington, 175 Hutchinson Avenue, Columbus OH 43235 Phone: 614-885-3334 Fax: 614-846-4353

Company/Organization: ___________________________________________________________ Contact Name and Title: ___________________________________________________________ Address: _________________________________________________________________________ City, State, ZIP: ___________________________________________________________________ Phone Number: ____________________________ Fax: ____________________________________ Email: ___________________________________________________________________________ NAMES & TITLES (WE MUST HAVE TITLES) of those hosting your booth (for name tag purposes) : 3. ___________________________________ 4. ________________________________________ Booth Cost:  BASA Partners: $500.00  Non-Partners: $1,000.00 Booth Information: Your booth will include 1 table with 2 chairs. Carpet is not needed. If you require electricity, please check the box below. You will be notified of your booth’s placement by February 28, 2014. Pop-Up Size: Height______ Width_____ Table Size:  6 foot  8 foot Do you wish for BASA to supply the table for your exhibit?  Yes  No Electricity Needed?  Yes  No Meal Tickets: Each exhibitor will receive 2 complimentary meal tickets for Continental Breakfasts & Lunch. Additional meal tickets may be purchased at a cost of $30.00 per person. Please provide ____ additional meal tickets. Total Cost: $_________________________ Payment Information:  I have enclosed my check for $_________ 1. ___________________________________ 2. ________________________________________

(Please make checks payable to Buckeye Association of School Administrators)  I would like to be invoiced by BASA (Note: Payment is due within 30 days of invoice)