2020 Exhibitor Detail Form

Thank you for your interest in exhibiting with us. Please complete the following form and provide the information so that we may process your order. We look forward to seeing you at the Maine Chapter ACS conference July 31 to August 2, 2020!


Contact Information

Company
Contact First Name
Contact Last Name
Title
Daytime Phone
Email

Exhibit Directory Listing Information

Company Name
Address
City State Zip
Daytime Phone Fax
Website
Register our company for:($1,495 per exhibit booth)
Our Company would also like to:
Contribute an attendee raffle item
Sponsor an attendee gift
Sponsor a Break (with signage)
Description of company and products/services (100 Words Max)
 

Directory Information for On-Site Representatives

Representative #1
Name
Title
Email
Cell Phone
Representative #2
Name
Title
Email
Cell Phone
Representative #3
Name
Title
Email
Cell Phone
Additional On-Site Representatives ($100 Each)
Representative #4
Name
Title
Email
Representative #5
Name
Title
Email
Total number of Representatives
Representatives attending the Welcome Reception (Complimentary):
 
Representatives attending the President's Dinner (Complimentary):
 

Special Requests

We prefer not to be located near the following companies:
Do you need electricity at your booth? (Note: You must bring your own extension cords)
Dietary restrictions or allergies: We hope that you will join us for meals and breaks. Please list any dietary needs or allergies below and we will do our best to accommodate your request.

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 (available online and sent with the email invitation). The MEACS agrees to provide booth space, furniture (one six-foot table and two chairs), and three complimentary registrations to all conference breaks and food functions. An attendee list will be provided at the conference.
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