2016 Summit to Sound Exhibitor Agreement


SUMMIT TO SOUND – NORTHWEST EMERGENCY MEDICINE ASSEMBLY

APRIL 28-29, 2016
BELL HARBOR INTERNATIONAL CONFERENCE CENTER | SEATTLE, WA

Company Name:

Primary Contact

Primary Contact Name:
Primary Contact Title:
Primary Contact Address:
Primary Contact Phone:
-
Primary Contact E-mail:*
Company Website:

Primary Booth Representative Contact

(This information will be published and distributed to attendees)

Primary Booth Rep Name:
Primary Booth Rep Title:
Primary Booth Rep Address:
Primary Booth Rep Phone:
-
Primary Booth Rep E-mail:

Representatives Staffing Your Booth

Two allowed, additional representatives $150 each
Rep #1 Name:
Rep #2 Name:
Rep #3 Name:
Rep #4 Name:

Exhibit Information

Product/Service to be displayed:
Please indicate companies you desire NOT to be located adjacent to (i.e. competitor):

Exhibiting Rates

Exhibition booth space early bird rate is valid through Feb. 26, 2016.


Exhibit Rate:
Total:
Please verify:

Upon completing the form and clicking "submit," you will be directed to PayPal to make the Exhibitor Agreement payment.

INQUIRIES
Contact Pauline Proulx, Chapter Executive, at the Washington ACEP office at 206-956-3648 or send emails to plp@wsma.org