2017 Mind Matters Conference Exhibitor Registration

Deadline: March 10

Contact Information

Exhibitor Name: 
Organization:
Address:
City:
State:   Zip Code:
Phone:
Email:
Special Needs: Please provide a written request for any special needs, including dietary.

Sponsorship Level

Payment

Once you submit this form, you will receive an invoice via email with payment instructions. Only checks are accepted. If you do not receive this within two business days please contact Michelle Graba at 701-777-3294.

The North Dakota Brain Injury Network periodically sends information on events, presentations, and news related to brain injury. As an attendee of the Mind Matters Conference, your email will automatically be included to receive these updates. Your contact information will not be sold or shared.

 I wish to opt out of having my contact information included.