2015 LPA FALL WORKSHOP
Saturday, November 7, 2015
Ralph and Kacoo’s
6110 Bluebonnet Blvd
Baton Rouge, LA
SPONSORSHIP INFORMATION
The Louisiana Psychology Association is hosting our 2015 Fall Workshop Saturday November 7, 2015.
We anticipate 40-60 attendees or more, mostly licensed psychologists
We would like to invite you to participate as a sponsor for our upcoming Fall Workshop.
Exhibitors will be furnished with a display table along with two chairs. If you are a Corporate Supporter Member
please join us for our upcoming convention by submitting the form below along with your check made payable to
the Louisiana Psychological Association in the amount of $250. If you are not a Corporate Supporter, please also
fill out the membership form and send in as well with your exhibitor fee of $250
Exhibit space will be allocated on a first come, first served basis
You can also pay for the Corporate Supporter Membership and the Conference Exhibitor online by visiting
our website – wwww.louisianapsychologist.org
Louisiana Psychological Association • P.O. Box 80053 • Baton Rouge, LA 70898
Voice 225•326•3180 Fax 225•208•1932 • www.louisianapsychologist.org
FALL WORKSHOP SPONSORSHIP SIGNUP INFORMATION
NAME: _________________________________COMPANY NAME: _________________________________
BINGO DOOR PRIZE BEING BROUGHT: _____________________________________
ADDRESS: _____________________________________________________________
CITY: __________________________________ STATE: ______
ZIPCODE: _______
TELEPHONE NUMBER: _______________________ FAX: ________________________
CELL PHONE NUMBER: _______________________ EMAIL ADDRESS: _____________________
HOW DO YOU WANT YOUR COMPANY’S NAME LISTED IN OUR PROGRAM?
____________________________________________________________________________________________
____________________________________________________________________________________________
PLEASE LIST ALL THOSE THAT WILL BE MANNING THE BOOTH SO THAT WE CAN HAVE A BADGE
FOR THEM:
____________________________________________________________________________________________
____________________________________________________________________________________________
Credit card payments can be faxed to (225) 208-1932
MAIL CHECK, MONEY ORDER OR PROVIDE CREDIT CARD INFORMATION BELOW TO
CHARGE YOUR DUES PAYMENT
Circle type of card:
MasterCard
Visa
DISCOVER
Cardholder’s Name __________________________________________________
Card Number: _____________________________________________________
Expiration Date: ____________________________________________________
Cardholder’s Zip code: ___________ Card Security Code: ____________________
Louisiana Psychological Association • P.O. Box 80053 • Baton Rouge, LA 70898
Voice 225•326•3180 Fax 225•208•1932 • www.louisianapsychologist.org