MACPS Speaker/Exhibitor Request Use this form to invite members of the Manufacturers Alliance for Child Passenger Safety (MACPS) to participate in your state or regional event that includes a Child Passenger Safety (CPS) program. We'd like to invite MACPS members to our conference:*Choose "Select All" or, if your conference can accommodate only a limited number, select the members you'd like to invite: Select All AMERICAN HONDA MOTOR CO., INC. BUBBLEBUM CHICCO CLEK DIONO DOREL JUVENILE GOODBABY INT. (Evenflo, CYBEX) HYUNDAI-KIA AMERICA IMMI MIFOLD NEWELL BRANDS (Graco Children’s Products, Baby Jogger) NUNA ORBIT BABY SAFE TRAFFIC SYSTEM (RIDE SAFER) SMARTRIDR, LTD (WHIZRIDER) SUMMER UPPABABY VOLKSWAGEN GROUP OF AMERICA Conference Contact (Submitter's Name):* Agency/Organization:* Telephone #:*Fax #:Email Address:* Enter Email Confirm Email Is this a multi-day event?* Yes No Event Date*Please enter the day of the event. MM slash DD slash YYYY Event Start Date*Please enter the first day of the event. MM slash DD slash YYYY Event End Date*Please enter the final day of the event. MM slash DD slash YYYY Event Format* In person Virtual In person, but speakers can participate virtually, if preferred Event Location:*Please describe the location where the conference will be held (facility/city/state). Closest Airport:*Please tell us the closest airport to your conference. If another viable airport option exists, please indicate that as well. Have you made arrangements for an event hotel?* Yes No Event Hotel: Type of Event:* Regional Statewide City/County/Coalition Within a State Event invitees are from this state(s):*Please tell us the state or states where most attendees live/work. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Is This Event Held Regularly?* Yes, annually Yes, biennially (every other year) Yes, monthly (or other) No Expected Attendance:*Last Year's Attendance:Has this event been advertised on a website?* Yes No Website Advertising the Event: Special Event Rate at Hotel:Please tell us what the special event rate is at the hotel.Event Type:*Please describe the event in more detail (CPS only, highway safety including CPS, etc.).What are you requesting?*Please indicate how you'd like manufacturers to participate in your conference. Exhibit at a booth Present as part of a manufacturer panel Present one or more CEU sessions (if selected, MACPS will get in touch to discuss options). Cost(s) to Manufacturer:*Please tell us if there are conference fees that manufacturers must cover (registration, exhibit fees, etc.)Expense reimbursement available for speakers:*Please tell us if any expense reimbursement is available for manufacturers who present CEU sessions (e.g., hotel, meals, registration, exhibit fees).