ABMC 2022: Vendor and Exhibitor Application

Alabama Black Midwives Conference: Vendor and Exhibitor Form

Alabama Black Midwives Conference: Our Past, Our Present, Our Future, Our Truth, May 20-21, 2022, in Tuscaloosa, AL. This conference will bring together practitioners, professionals, politicians, and health system leaders from across the state of Alabama, the southern United States, and nationally, to celebrate the passage of a law that established the regulation of licensed midwives in Alabama in 2018 called HB 315. This is the first step in increasing access to the midwifery model of maternal and infant care and increasing the number of Black midwives in Alabama.

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Event Information

The conference will take place at the Hotel Capstone (May 20th, 2022) and the UA Bryant Conference Center (May 21st, 2022). These conference sites are just steps away from each other on the University of Alabama campus in Tuscaloosa, Alabama.

Hotel Capstone (Conference location for May 20th, 2022)
The first day of the event will take place at the Hotel Capstone. You can view the floor plan of the hotel here. The conference will take place in the Conference Center area. The exhibit will be in the Governor's Room for both days of the event.

UA Bryant Conference Center (Conference location for May 21st, 2022)
The second day of the conference will be hosted at the UA Bryant Conference Center. You can view the floor plan of the conference space here. The conference will take place in the following spaces: the Registration Lobby, the Sellers Auditorium, the Sellers Lobby, and the Nichols Room.

Vendor and Exhibitor Badges

You can have up to two people at your table. Each contact will receive a badge to wear when onsite at the conference. The badge provides access to the Vendor and Exhibitor area during set-up, open hours, and break-down.

Equipment: Included and Optional

The conference will provide 1 6-foot table, 1 6-foot table cloth, and 2 chairs. You are welcome to provide your our own additional equipment within the allocated space. Generators, heating vents, and hazardous equipment are prohibited.

Vendor and Exhibitor Information

I AM APPLYING TO PARTICIPATE AS A:

Vendor

Exhibitor

Contact Information

Full Name: (Contact 1)

First Last

Full Name: (Contact 2)

First Last

Do you give permission for pictures of your booth at the ABMC to be used on our website and Facebook page for promotional purposes?*

Yes

Business Description

Describe specific products/materials that you propose to exhibit at the conference:*

Be sure to include all products that you intend to exhibit, sell, or give way, including promotional materials. We reserve the right to deny further participation to vendors and exhibitors who sell, exhibit or market products that have not been disclosed on this form.

Describe specific products/materials that you propose to sell at the conference.*

Be sure to include all products that you intend to sell or give way, including promotional materials. We reserve the right to deny further participation to vendors and exhibitors who sell, exhibit or market products that have not been disclosed on this form.

Equipment: Included and Optional

The conference will provide 1 6-foot table, 1 6-foot table cloth, and 2 chairs. You are welcome to provide your own additional equipment within the allocated space. Generators, heating vents, and hazardous equipment are prohibited. .

EQUIPMENT TYPE	COST
6-Foot Table x1	Included- $0
Tablecloth x1	Included- $0
Chair x2	Included- $0
Outlets x2	Not Included-$20

If you plan to bring additional equipment, please list your items:

Media Release and Consent*

I hereby agree and give my permission for Shafia Monroe Consulting to record, film, photograph, audiotape or videotape myself(hereinafter collectively referred to as “Works”) and to display, publish or distribute these Works for the purpose of publishing, posting on the Shafia Monroe Consulting website and posting on Shafia Monroe Consulting social media sites. I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I waive any right to any royalties related to the use of these Works. I understand that the Works may appear in electronic form on the internet or in other publications outside of the Shafia Monroe Consulting’s control. I agree that I will not hold the Shafia Monroe Consulting responsible for any harm that may arise from such unauthorized reproduction.

I hereby consent to the use of my personal photograph and photographs provided and grant permission to SMC to the rights of the images, without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

My personal photograph and photographs, photographic images, audio recordings, and video recordings may be used by SMC for the following purposes:
• educational presentations and publications
• informational presentations and publications
• online materials developed by SMC
• Program promotion print and social media
I will be consulted about the use of the photographs for any purpose other than those listed
above.

By signing this release, I agree photographic images, audio recordings, and video recordings of me may be electronically displayed via the Internet on the SMC website and SMC Facebook Page and other SMC Social Media Pages.
There is no time limit on the validity of this release nor is there any geographic limitation on
where these materials may be distributed.

By signing this form, I acknowledge that I have completely read and fully understand the above
release and agree to be bound thereby. I hereby release all claims against any person or
company utilizing this material for educational or informational purposes.

I agree to consent the Media Release

COVID19 Safety Policy

COVID19 Safety
We want everyone to feel welcome and safe at this conference. Masks and social distancing will be required for both days of the conference. For more information, please see the Centers for Disease Control and Prevention's guide for masks by clicking here. Temperature checks will be taken at registration each day. Entry without a mask will not be permitted for Vendors or Exhibitors, under any circumstances. If you feel sick, please do not attend and contact us to update your badge details.

I agree to the COVID19 Safety Policy.

What Days Will You Vend?*

What Day(s) Will You Exhibit?*

Total

How would you like to checkout?*

PayPal

Debit or Credit Card

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Payment Method

This field is for validation purposes and should be left unchanged.

Alabama Black Midwives Conference: Vendor and Exhibitor Form

Event Information

Vendor and Exhibitor Information

Contact Information

Equipment: Included and Optional

EQUIPMENT TYPE

COST

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