Let’s work together Business Name (to be displayed) * Email * Contact Person's Name * First Name Last Name Contact Person's Phone * (###) ### #### Business Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Preferred Method of Contact * Phone Email Either Please explain the type of service or goods and how it benefits children, mental health, or families * Booth will have one 6’ x 30’’ table and chairs, do you think you will need more? If so, how many? Will you need access to electricity? * Yes No Not Sure Would you be interested in donating a small prize as a door prize? * Yes No Not Sure Any other items you may need or would like us to know? Select the following applicable Exhibitor Fee: (payment is not due until a representative has confirmed your application) * Member of APT/MAPT: $70.00/day Non-Member of APT/MAPT: $75.00/day Non-Profit Organization: $50.00/day Thank you! Your request has been submitted. We look forward to working with you. We will reach out to you as soon as possible.
