MEACS 2018 Exhibitor Detail Form

Thank you for Exhibiting with us. Please complete the following information so that we may process your order.

Contact Information

Company
First Name Last Name
Title
Daytime Phone
Email

Exhibit Directory Listing Information

Company Name
Address
City State Zip
Daytime Phone Fax
Website
 Description of Company and Products/Services (100 Words Max)
 

On-Site Representative

Please provide representative information below.
Representative #1
Name
Title
Email
Representative #2
Name
Title
Email
Representative #3
Name
Title
Email
Additional On-Site Representatives ($100 Each)
Representative #4
Name
Title
Email
Representative #5
Name
Title
Email

Registration Information

Please Reserve Our Company for the Following:
Exhibit Space - $1,495
Number of Representatives:
Number of Attendees to Welcome Reception - Complimentary:
Our Company would like to be a:
Major Supporter (includes exhibit space and additional recognition:
Break Supporter (with signage):
If possible, please do NOT Locate us near the following companies
 
Electricity needed? (Note: You must bring your own extension cords)

Agreement

The Maine Chapter, American College of Surgeons, hereinafter referred to as Maine Chapter, is hereby requested and authorized to reserve exhibit space for our use during the ME Chapter Annual Meeting. It is understood and agreed that all space will be assigned on a first-come, first-served basis and that Maine Chapter reserves the right to decline any application or disallow any exhibit which is not in keeping with the character of the meeting and to make reasonable shifts in location for the benefit of the exhibitor or deadlines and details. Exhibitors are bound by the exhibitor specifications and conditions on the Exhibitor Agreement.
I have read and agree to the terms and conditions of this contract and the Exhibitor Agreement
(please initial)

Total Amount Due

Total Amount Due will be Provided on Next Screen.

Tax ID # 20-4019098
(The MEACS W-9 Form can be requested by emailing maine@mainefacs.org)
   - denotes required fields