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State or Regional Exhibiting Award Application

1. Name of Network Member Institution:
*

2. Network Member LIBID:
*

3. Exhibit Lead:
*

4. Position/Title of Exhibit Lead:
*

5. Mailing Address:
Street 1:  *
Street 2: 
City:  *
State:  *
Zip Code:  (e.g., 99999 or 99999-9999) *

6. Email Address (e.g., maryc@project.org):
*

7. Telephone Number [e.g., (222) 222-2222 or 555-555-5555]:
*

8. Fax Number [e.g., (222) 222-2222 or 555-555-5555]:
*

9. Award funding is $2,000.00 please supply a brief budget.
  • Funding will cover registration and booth fees, travel and per diems, communication costs, publicity, promotional items, and equipment rental if needed. Provide an explanation for other costs needed not listed above.
  • Meal per diems are the only allowable food expenditure.
  • No indirect costs are allowed.
  •  Furniture costs are not allowed.
  • No costs for promotional items are allowed.
Expenditure Category Description Total Charges
Booth Space Cost
Other Booth Costs (furniture rental or carpeting)
Travel Costs (mileage and parking)
Other Travel Costs, if applicable (lodging and per diem)
Internet Connection Cost, if applicable
Shipping Costs
Marketing Costs, if applicable (ex. reproduction)
Additional Costs (please describe)
Total Amount Requested ($2,000 maximum): $0

10. Award should be made payable to what institution (i.e., Southeastern Regional Medical Center)?
*

11. Federal Tax Id Number (FEIN):
*

*

*

14. Name of meetings or sponsoring organization; date and location of exhibit.
200 characters left

15. Expected audience (e.g. "Public health professionals in Florida. Average annual meeting attendance is 400.")
4,000 characters left

16. Describe physical exhibit, handouts, and any special focus or theme.
4,000 characters left

17. Please give the names of the expected booth staff.
4,000 characters left

18. Other participation in this meeting? Will you give a talk, teach a workshop, or network in some other way?
4,000 characters left

19. Comments
4,000 characters left

 the form then submit to the SE/A office for review

Contact us at:

NN/LM SE/A Region

University of Maryland, Baltimore

Health Sciences and Human Services Library

601 W. Lombard Street

Baltimore, MD 21201-1512

Phone: 1-800-338-7657 or 410-706-2855

Last updated on Tuesday, 03 May, 2011

Funded by the National Library of Medicine under contract HHS-N-276-2011-00004-C with the Health Sciences and Human Services Library of the University of Maryland