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Exhibitor Information
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| ONLY TWO REPRESENTATIVES PER TABLE
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| Company Name | |
| Product Name | |
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| Primary Local Representative first name | |
| Primary Local Representative last name | |
| Primary Representative e-mail address | |
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| Second Local Representative first name | |
| Second Local Representative last name | |
| Second Local Representative e-mail address | |
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| Third (rotating) Local Representative first name | |
| Third (rotating) Local Representative last name | |
| Third (rotating) Local Representative e-mail address | |
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| Fourth (rotating) Local Representative first name | |
| Fourth (rotating) Local Representative last name | |
| Fourth (rotating) Local Representative e-mail address | |
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| First Local Representative first name | |
| First Local Representative last name | |
| First Local Representative e-mail address | |
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| Billing Contact Information
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| Please note if you plan to pay by credit card, be ready with payment or form will not save/submit.
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| If payment method unknown or unable to pay by credit card at time of registration, choose pay by check. You can contact us when ready to pay by CC, if this is the desired method of payment
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| Company Name (or Third Party Co.) Responsible for Payment | |
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| Last | |
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| Address | |
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| City | |
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Exhibit Options and Cost
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Bronze - $1,000
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| One-day exhibition which includes scheduled breaks. Exhibit cost includes:
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| • Six foot covered and skirted table with two chairs / your staff
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| • Complimentary lunch for two staff
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| • Company name listed in program
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| • List of registered physician’s names
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Silver Product Theater (Friday) Contact Us for Price
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| Your speaker will provide a non-CME presentation on Friday, January 23. Exhibit cost includes:
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| • All items under BRONZE level including exhibit table Friday
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| • Preferred exhibition table location
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| • Extended speaking duration at desired time
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| • Breakfast will be served during product theater
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| • Basic audio-visual needs for speaker (laptop, microphone, projector/screen)
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Silver Product Theater (Saturday) Contact Us for Price
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| Your speaker will provide a non-CME presentation on Friday, January 23. Exhibit cost includes:
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| • All items under BRONZE level including exhibit table Friday
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| • Preferred exhibition table location
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| • Extended speaking duration at desired time
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| • Breakfast will be served during product theater
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| • Basic audio-visual needs for speaker (laptop, microphone, projector/screen)
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Gold Product Theater (Friday) SOLD OUT
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| Your speaker will provide a 55 min non-CME presentation on Friday, January 23. Exhibit cost includes:
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| • All items under BRONZE level including exhibit table Friday
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| • Preferred exhibition table location
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| • Extended speaking duration at desired time
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| • Lunch will be served during product theater
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| • Basic audio-visual needs for speaker (laptop, microphone, projector/screen)
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SOLD OUT Gold Product Theater (Saturday) SOLD OUT
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| Your speaker will provide a 55 min non-CME presentation on Saturday, January 24. Exhibit cost includes:
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| • All items under BRONZE level including exhibit table Friday
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| • Preferred exhibition table location
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| • Extended speaking duration at desired time
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| • Lunch will be served during product theater
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| • Basic audio-visual needs for speaker (laptop, microphone, projector/screen)
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Payments and Cancellation Policy
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| Exhibit fee due on or before January 9th. Due to the limited number of spaces available, spaces cannot be held and is only secured when payment is received. If paying by credit card an additional fee of $150 will be applied. Cancellation requests must be made in writing. Refunds provided if the event is canceled.
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| Please choose your Exhibitor Level option below:
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| Please choose your payment method below:
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| If you plan to pay by credit card, have payment ready or this form will not save/submit. If payment method unknown at this time, choose pay by check. Credit card payment can be made at another time.
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