Hospital Pharmacist Association of Ireland
Annual Educational Conference Exhibition Registration Form
April 8th – 10th 2016
Exhibition Date, Time & Venue
10.45am – 12.45pm, Saturday April 9th 2016,
Crowne Plaza Hotel
Santry
Dublin
Please Complete and Forward to:
Elaine Conyard,
HPAI Conference Business Manager
c/o Pharmacy Department,
Our Lady of Lourdes Hospital, Drogheda
E-mail: [email protected]
1. Company Details
Company Name
Address
Contact name for
Exhibitor
Contact e-mail for
Exhibitor
Telephone & Fax
2. Stand Size Required
Please indicate the size of the stand space required & the type of stand you will have on display. In selecting the
stand space required please ensure that your stand display will comfortably fit within the space selected.
Stand space
Banner (Pull Up)
Pop Up Stand
Cost
Stand Space Size
required
Stand(s)
8 ft
□
□
□
€1000
10 ft
12ft
(a small number are
available on request)
□
□
□
€ 1250
□
□
□
€1500
Further Information: Your choice of stand size will be facilitated where possible and a plug socket is available with
each stand space booked. Please indicate if you have any particular requirements in relation to your stand e.g.
additional plug sockets required, prefer stand not be adjacent to or facing the following exhibitors or types of exhibitors
etc. The HPAI will make every effort to accommodate your request in the planning of the event, where possible,
however please understand it may not be feasible to fulfil all requests.
3. Gala Dinner Tickets
 Two complementary gala dinner tickets are available with the booking of each stand.
 Additional dinner tickets may be made available on request.
 Dinner ticket requirements need to be confirmed by Thursday 31st March 2016.
Elaine Conyard, HPAI Conference Business Manager, c/o Pharmacy Department, Our Lady of Lourdes Hospital, Drogheda
Tel: 041 9874663 / 086 810 3350 E-mail: [email protected]
4. Payment Details - Please indicate your choices below.
Payment Method
Electronic Fund Transfer
Cheque
Invoice Required
Yes
No
Yes
No
Receipt of Payment Required
Bookings will be accepted on a provisional basis on receipt of the completed booking form and confirmed
when payment is received. The closing date for booking a stand is Friday March 25th 2016
5. HPAI Bank Account Details for Electronic Fund Transfer (EFT)
Account Name:
Hospital Pharmacists Association of Ireland
Bank Name & Address
Allied Irish Bank , Main St, Dundrum, Dublin 14
Bank Account Number
06825043
Sort Code Bank
93-31-20
IBAN Number:
IE58 AIBK 9331 2006 8250 43
Swift/BIC
AIBKIE2D
Essential Information
Required on EFTs
The company making the EFT must provide their company name as the
payment reference information on the EFT
Remittance advice note /
confirmation of payment
must be sent to.
Elaine Conyard, HPAI Conference Business Manager
Via e-mail or post, contact details provided at the top of the registration form.
6. Transfer of Value Disclosure Forms
If an exhibitor requires the HPAI to complete a transfer of value disclosure form it would be appreciated if the
form could be e-mailed or posted to the Conference Business Manager with the stand booking form.
7. Further Information / Queries

The ‘HPAI 2016 Pre-conference Update for Exhibitors’ has been circulated with this booking form
which provides further information on the facilities for exhibitors and the set up of the exhibition.

The ‘HPAI 2016 Conference Programme Flyer’ has also been circulated with this booking form and
provides details of the programme for the conference and the educational events that will be taking
place.

If you require further information after reading the conference flyer and the update for exhibitors please
do not hesitate to contact the HPAI Business Manager at [email protected]
Elaine Conyard, HPAI Conference Business Manager, c/o Pharmacy Department, Our Lady of Lourdes Hospital, Drogheda
Tel: 041 9874663 / 086 810 3350 E-mail: [email protected]
Elaine Conyard, HPAI Conference Business Manager, c/o Pharmacy Department, Our Lady of Lourdes Hospital, Drogheda
Tel: 041 9874663 / 086 810 3350 E-mail: [email protected]