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Community Partner Exhibitor Registration Form

Thank you for your interest in exhibiting at the 2026 Louisiana State EMS Education Conference & Expo!

Community partner exhibitor space is provided at no cost and is intended for organizations that support EMS, public health, safety, education, and community services.

Organization Information

Organization name*

Organization Type (check all that apply)*

Government Agency

Non-Profit Organization

Educational Institution

Public Health Organization

Community Resource/ Advocacy Group

Other

Brief Description of Organization Services*

______________________________________

Primary Contact Information

First name

Last name

Position

Phone

______________________________________

Exhibitor Details

How many representatives will be present at your exhibit?*

Do you plan to distribute educational information or giveaways?*

Yes

Do you require electricity at your exhibitor table?*

Yes

Do you require any special accommodations?*

Yes

If special accommodations are required, please provide a brief description.

______________________________________

Agreement & Acknowledgement

I acknowledge that this exhibitor opportunity is provided at no cost to approved community partners.

I understand that exhibitor space is limited and registration does not guarantee placement until confirmation is received.

I agree that our organization’s mission aligns with the educational and professional goals of the Louisiana State EMS Education Conference & Expo.

Authorized Representative Name*

Date picker

Louisiana Rural Ambulance Alliance

3695 BANK DRIVE

ST. GABRIEL, LA 70776

985-513-3593

admin@LRAAresponse.org

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Community Partner Exhibitor Registration Form

Organization Information

______________________________________

Primary Contact Information

______________________________________

Exhibitor Details

______________________________________

Agreement & Acknowledgement

Louisiana Rural Ambulance Alliance

© 2025 Louisiana Rural Ambulance Alliance | The Louisiana Rural Ambulance Alliance is a registered Louisiana non-profit.