Indiana Dental Hygienists' Association 
                                                                                                                                           


SPONSOR/EXHIBITOR AGREEMENT


Click here to print:  Sponsor/Exhibitor Agreement

(Please print clearly; IDHA will publish the company name as shown on this form.)

Category (please check one):

1 Sponsor (select one of the four levels below):

1 Platinum
1 Gold
1 Silver
1 Bronze

1 Exhibitor-Only

1 Samples Donor
(provide 300 samples to go to registrants at IDHA’s discretion)



COMPANY NAME:                                                                                                                   

DIVISION OF/PARENT COMPANY:                                                                                       

MAILING ADDRESS:                                                                                                                

CITY, STATE, ZIP:                                                                                                                    

WEB ADDRESS*:                                                                                                                      

PRIMARY CONTACT*:                                                                                                            

CONTACT PHONE:                                                        FAX:                                                 

Be sure and read the criteria, included in the Benefits of Sponsorship, regarding linking your Company’s web site and importing your logo.

Exhibitor registration includes one free buffet lunch.

NOTE: Any company fully sponsoring an out-of-state speaker is considered a Platinum Sponsor.


*Required information—Application cannot be processed unless this information is provided.


MISSION STATEMENT OF THE AMERICAN DENTAL HYGIENISTS’ ASSOCIATION

To improve the public’s health, the mission of the American Dental Hygienists’ Association is to advance
the art and science of dental hygiene by ensuring access to quality oral health care, increasing awareness of the cost-effective benefits of prevention, promoting the highest standards of dental hygiene education,
licensure, practice and research, and representing and promoting the interests of dental hygienists.

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