DHASNY and Components Professional Education Public Policy and Advocacy Licensure and Practice Consumer Information
Students CE Calendar Join Us Resources Thanks to Exhibitors Contact Us NY HYPAC Home

Download a PDF of this form

DHASNY 97th Empire Conference Exhibitor Registration Form

November 3-4 2017 - Crowne Plaza, White Plains, NY

Exhibitors Hall will be held Friday November 3, 2017 from 6 p.m. – 8 p.m. AND also Saturday Nov. 4, 2017 from 8 a.m. 1 p.m. 

Crowne Plaza
66 Hale Ave.
White Plains, NY 10601

(914) 682-0050 


Booth size will be 10 feet by 8 feet in size. We will provide one draped table and two chairs. The total cost for each booth is $450.00, payable to DHASNY. Booth fee is the same whether participating both days or just one day; please specify Friday or Saturday or both days. Booth locations will be assigned at the discretion of the Conference Exhibit Chair. Overall product lines, number of booths and order in which booth reservations were received will be taken into consideration.

Check all that apply*

AGREEMENT: On behalf of my company, I hereby commit the undersigned firm to exhibit at the 97th Empire Conference of the Dental Hygienists’ Association of the State of New York, Inc. in 2017. 

Company Name:*
Contact Person:*
Number of Booths:*
Days Participating:
Name Tag Should Read:*
Company Website:
Briefly describe your product line:

As an exhibitor, I understand that no booth shall be for more than one exhibitor, no subletting is allowed and written requests for return of booth fee will only be accepted up to 60 days prior to the conference. I agree to be at the booth through the full show on the day(s) designated. 

Your Name:*
Your Title:*
Total to be charged to your card (please use numbers only, no periods):*

When you click on Submit, you will be taken to PayPal to complete your payment securely. You can use your PayPal account, or use your credit card if you don't have a PayPal account. NOTE: In PayPal, you must click on the "Credit Card" tab at the top of where you enter your card information. "Debit Card" is selected by default. When you are finished with your payment, you will receive a confirmation email.

Please type in the characters you see: