Vendor Registration Company Name(Required)Representative's Name(Required) First Last 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 Phone(Required)Email(Required) 2025 Conference(Required) Fall Conference – Day 1 Fall Conference – Day 2 Sponsorship Levels Diamond Level – $1000.00 – booth fee and Sputum Bowl sponsor. Vinyl banner to hang at the conference, company logo to be listed on WYSRC website & social media. Platinum Level – $750.00 – booth fee and door prize sponsor. Includes company logo to be listed on WYSRC Website. Silver Level – $450.00 – booth fee onlySponsorship Fee(Required)Diamond LevelPlatinum LevelSilver LevelCompany LogoPlease attach a company logo for us to utilize on website, social media, conference agenda, etc. Max. file size: 512 MB.Please select if you need any of the following: Electrical Outlets Additional Linens Terms of Service(Required)The WYSRC reserves the right to the following cancellation policy: + A full refund, minus transaction fees (3%), will be issued if cancellation of registration is requested in writing 30 days prior to the conference. + No refund is available if canceling less than 30 days prior to the conference. + Photographs taken during the conference may be used in future WYSRC publications and promotions. I agree to the Terms of Service Total Payment Choice(Required)Credit / Debit CardCheckCredit Card(Required)Card Details Cardholder Name Thank you for choosing to pay by check. Make checks payable to: Wyoming Society for Respiratory Care. Mail to PO Box 52 Casper, Wyoming 82602. This information will be available on the confirmation page and email message.Speaker Consideration:If you have a speaker that you would like us to consider for a conference, please enter their name and contact information. If you are interested in speaking, either in association of your company or personally, please fill out a speaker form.PhoneThis field is for validation purposes and should be left unchanged.
