Exhibitor Information
* I am a:
Non-profit registered with the IRS/State of Florida and provides 75% of services to special needs co ($350.00)
For-profit business that provides 75% of services to special needs community ($800.00)
* Were you a registered Resource Exhibitor at Make 'm Smile in 2022?
Yes
No
Profit
Non-Profit
* Please attach 501(c)(3) IRS determination letter or FL certificate of exemption:
(max file size: 5MB, file types: .jpg, .png, .gif, .pdf)
Did you return your tent signs from last year?
Yes
No, but I plan to bring it back this year
No, and I will not/cannot bring it back this year
* How did you hear about Make 'm Smile?
I was referred by another organization
TV/News/Radio
Billboard
Web
Flyer/Poster
Friend/Family
Other
* Who referred you?
* Your Organization Name (for signage):
* Brief description of your organization (Limit 50 words)
* Area of service?
Adult Programs
Crisis Care
Disability Related Organizations
Disability Related Products
Education (Schools, Scholarships, Tutoring)
Enrichment and Fun (Sports, Music, Camps, etc)
Legal Services (Guardianship, Special Needs Trusts)
Medical (Home Healthcare, Hospitals, Providers, Specialists)
Mental Health
Respite/Daycare/After School Care
Support Groups
Therapy
* Contact Name:
* Mailing Address:
* City:
* State:
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
* Zip:
* Email:
* Office Phone:
Website:
LinkedIn URL:
Twitter URL:
Facebook URL:
Company Logo:
(max file size: 5MB, file types: .jpg, .png, .gif)
Day-of-Event Contact Information
* Contact Name:
* Cell Phone (not office #):
* Contact Email:
Backup Contact Name:
Backup Cell Phone (not office #):
Back-up Contact Email:
# of Adults Working Booth:
You can bring as many people to work your booth as you would like, but your registration only includes up to (2) Event Wristbands . Event wristbands are required for food and drinks (excluding Chick-fil-A. We are only offering them free to our VIPs and their immediate families.) If you have more than (2) coming to work your booth, you will be able to purchase additional wristbands in advance or at the event/donation of $5 per wristband.
Additional Wristbands ($5 each):
What activity and/or give away are you bringing to the event?
Required: One craft, activity and/or give-away item for our VIP kids (If you need ideas or have questions about kid friendly activities please call 407-857-8224)
Beyond the standard set-up provisions, what might you need? (hose water and electricity will be prioritized for use, based on limited supply)
Water for your activity ($45)
Electricity ($45)
Extra Table ($25)
Extra Chairs ($10 each)
Please explain your need in the "Additional Setup Information" box below. We will do our best to accommodate your request. You ARE permitted to bring your own extra tables and chairs if you do not want us to provide extras.
What type of water accomodation do you need?
Hose
Buckets
How many buckets of water?
Purpose for electricity (why it's needed):
How many additional tables?
How many additional chairs?
Additional Setup Information
Are you paying by check? (Check must be received by May 1, 2023, unless you call to explain alternate arrangement)
Payment Information
* Name on Card:
* Billing Address:
* Card Type:
Visa
Mastercard
American Express
Discover
* Card Number:
* Security Code:
* Card Expiration:
mm
01
02
03
04
05
06
07
08
09
10
11
12
/
yyyy
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Sub Total:
$0.00
Processing Fee:
$0.00 This allows your organization pre-event publicity on our website, so that VIP families can see that you'll be at the event! It's pretty cool.
Discount Total:
$0.00
Grand Total:
$0.00
Do you have a coupon code?
Exhibitor Acknowledgement, Release & Waiver (scroll down and click "I agree" to continue)
By Participating in this event, and submitting this Exhibitor registration, you are acknowledging the following:
Release: Exhibitor is participating in Make 'm Smile ("Activity") voluntarily, and does hereby release and forever discharge and hold harmless Nathaniel's Hope and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Exhibitor's participation in the Activity. Exhibitor understands that this release discharges Nathaniel's Hope from any liability or claim that Exhibitor may have against Nathaniel's Hope with respect to any bodily injury, personal injury, illness, death or property damage that may result from Exhibitor's participation with the Activity, whether caused by the gross negligence of Nathaniel's Hope or its officers, directors, employees, agents, or otherwise. Exhibitor also understands that Nathaniel's Hope does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness. Exhibitor understands that, except as otherwise agreed to by Nathaniel's Hope in writing; Nathaniel's Hope does not carry or maintain health, medical, or disability insurance coverage for any Exhibitor. Each Exhibitor is expected and encouraged to obtain his or her own medical or health insurance coverage.
Photographic Release: Exhibitor does hereby grant and convey unto Nathaniel's Hope all right, title, and interest in any and all photographic images and video or audio recordings made by Nathaniel's Hope during the Exhibitor's Participation in the Activity, including but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. Other: Exhibitor expressly agrees that this Release is intended to be as broad and inclusive as permitted by laws of the State of Florida, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Florida. Exhibitor agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provision of this Release which shall continue to be enforceable.
I affirm that I have read and agree to all information in this waiver.
By Using the Event Essentials System you agree for Event Essentials to use your personal information to complete the Purchase, Donation, and/or Registration. For more information click here .