Join Us This May at the Lake of the Ozarks Exhibit at the LeadingAge Missouri Conference IMPORTANT NOTE Please refer to this PDF when filling out the exhibit form for key details. Prefer to pay via check? Please mail a check with the completed PDF form. Organization(Required)Contact Person(Required) First Name Last Name Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website(Required) Contact Person's Phone(Required)Contact Person's FaxContact Person's Email(Required) For On-Site Program Brochure: Please list the company name, representative, address, phone number, and e-mail address as it should appear in the final program, if different from above.Preferred Booth Location #1(Required)Refer to the exhibit layout in the conference prospectus.Preferred Booth Location #2(Required)Refer to the exhibit layout in the conference prospectus.Preferred Booth Location #3(Required)Refer to the exhibit layout in the conference prospectus.List any companies you do not wish to be placed near. Add RemoveUse the (+) button to add more.Please provide, in 20 words or less, a description of your products and/or services to be published in the on-site brochure. LeadingAge Missouri reserves the right to edit any material.(Required)Booth Worker #1 Name(Required) First Last Exhibit hall passes for two booth workers are included at no additional cost.Booth Worker #2 Name First Last Exhibit hall passes for two booth workers are included at no additional cost.Exhibit hall passes for additional workers ($50/each) Quantity Price: $50.00 Quantity Names of additional workers for exhibit hall passesFirstLast Add RemoveIs your organization a current LeadingAge Missouri member?(Required) Yes No Member Booth Rental Fee Quantity(Required) Price: $850.00 Quantity Please enter a quantity of at least 1. Multiple booths can be rented.Non-Member Booth Rental Fee Quantity(Required) Price: $1,400.00 Quantity Please enter a quantity of at least 1. Multiple booths can be rented. The non-member exhibiting fee includes a $550 LeadingAge Missouri membership for the remainder of the calendar year 2025.Please agree.(Required) The terms and conditions printed in the Exhibitor Prospectus/Sponsor/Advertising Opportunities brochure are hereby incorporated by reference, and we agree to be bound by them. We agree that we shall accept the booth space assigned. LeadingAge Missouri is authorized to reserve exhibit space for our organization’s use as indicated above.Credit Card