Download a PDF of this form

NYDHA Virtual Empire Conference Exhibitor Registration Form

October 23-24, 2021

Multiple Engage Segments to Connect With Exhibitors, Attendees


We will provide a virtual booth through the Whova app with multiple features for exhibitors to share information and interact. The total cost for each booth is $400.00, payable to NYDHA.
The $400 fee covers both days of the conference.

PLEASE NOTE: Payment is necessary in order to receive the credentials to provide the company profile and virtual booth on the conference app.

Please provide fee by credit card below or make checks payable to NYDHA and mail with agreement to NYDHA Empire Conference, PO Box 16041, Albany NY 12212.

Check all that apply*

AGREEMENT: On behalf of my company, I hereby commit the undersigned firm to exhibit at the Virtual Empire Conference of the New York Dental Hygienists’ Association, Inc. in 2021.

Company Name:*
Contact Person:*
Company Website:
Briefly describe your product line:

As an exhibitor, I understand that no virtual 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.

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 or debit card if you don't have a PayPal account. Simply click on the Pay with Credit or Debit Card button at the bottom of the login window. When you are finished with your payment, you will receive a confirmation email.

Help Us Fight Spam