Oklahoma Assistive Technology Equipment Exposition
Confirmation Form

The equipment exposition is scheduled for Tuesday, December 8th at the Moore-Norman Technology Center, South Penn Campus (OKC Area).

Please confirm your attendance by completing this form and mailing a check for $100.00 to:

OATC
1600 N. Phillips
Attn: Sandra Keeler
Oklahoma City, OK 73104

Please make checks payable to the "Oklahoma Assistive Technology Center." and clearly indicate on the check your company name. Reservations are due by October 12, 2009. There will be an additional $50 fee for Confirmation Forms postmarked after October 12th.

Note: If you need assistance with this form please email sandra-keeler@ouhsc.edu or stefanie-olson@ouhsc.edu. Or call Sandra at 800-700-6282 or Stefanie at 918-660-3279

Company Name:
Representative Information
Name:
Address:
City:
State:
Zip:
Phone:
Email:
Fax:

Amount Due & Method of Payment
Confirmation Form postmarked on or before October 12, 2009 Confirmation Form postmarked after October 12, 2009	$100 fee before October 12, 2009 $150 fee after October 12, 2009
Method of Payment	Check Other

Products to be displayed at expo (please be SPECIFIC and give formal names of products):

How many tables and/or floor space will you need for your demonstration booth (each table is 3 feet deep x 6 feet long)
Tables: and/or floor space	Length W
Will you require electricity to run your booth? Yes No

BREAKOUT SESSIONS
We will schedule breakout sessions in separate rooms during the conference so that you may present your products or services in a more formal setting and have the opportunity to answer specific questions from participants. You will have one hour for this presentation.

Are you interested in doing a scheduled presentation? Yes No

We will provide a written description of each presentation to participants. Please complete the information below. BE SPECIFIC: WE WILL PRINT THIS INFORMATION IN THE PROGRAM EXACTLY AS YOU WRITE IT BELOW.

Title of presentation:
Presenter(s):

Description of presentation (give an overview of the session and/or its importance and relevance):

Information about the presenter(s) (describe pertinent information about the presenter(s) you want to include such as education, experience in the field, experience as a presenter, etc).:

Place a check next to the equipment that you will need during your presentation:

Overhead Projector | TV/VCR | Projection System for Computer PC or MAC

If you have questions, please contact Sandra Keeler at 800-700-6282 (sandra-keeler@ouhsc.edu) or Stefanie Olson at 918-660-3279 or stefanie-olson@ouhsc.edu This form must be completed and returned with your registration fee by October 12, 2007. Thank you for your participation!

CONTACT INFORMATION

OKLAHOMA ASSISTIVE TECHNOLOGY CENTER
UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER
DEPARTMENT OF REHABILITATION SCIENCES - COLLEGE OF ALLIED HEALTH
1600 N. Phillips
Oklahoma City, OK 73104
(405) 271-3625; TDD (405) 271-1705; FAX (405) 271-1707
(800) 700-OATC (6282)

OATC OKC Map

OKLAHOMA ASSISTIVE TECHNOLOGY CENTER
UNIVERSITY OF OKLAHOMA-TULSA
DEPARTMENT OF REHABILITATION SCIENCES – COLLEGE OF ALLIED HEALTH
4502 East 41st Street
Tulsa, OK 74135
(918) 660-3261; (918) 660-3279
FAX: (918) 660-3297

OATC TULSA Map