2017-2018 Signature Partnership Agreement


EMERGENCY MEDICINE LEADERSHIP SUMMIT | NOVEMBER 10, 2017 | THE CONFERENCE CENTER AT SEATAC
2018 SUMMIT TO SOUND | DATE: MAY 31-JUNE 1 | BELL HARBOR CONFERENCE CENTER, SEATTLE

Company Name:
Company Website:

Primary Contact

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

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

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):

Signature Partnership

2017-2018 Signature Partnership - $1000
Total:
Please verify:

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

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