1.Company Registration

Exhibit Coordinator Name

Company

Address

Address 2

City/Town

State/Province

AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming

ZIP/Postal Code

Country

Email Address

Phone Number

2.Select Exhibit Level

Platinum Level $7,500 (limited to first 4 paid companies)
o Choice of Premium Exhibit Booth location in Exhibit Area (first come,
first serve basis)
o Individual company acknowledgement signage
o Special name badge designation
o Up to 6 company representatives
o 4 complimentary conference attendees for CE credit
o PowerPoint slideshow acknowledgement
o Company listing in printed Exhibitor Directory
o One 6ft draped table
o Complimentary Electrical Services (if required)
o Attendee List (for attendees who have provided consent to have their
information shared)

Gold ($5,000) - one six foot table display, four representatives, company acknowledgements on PowerPoint slides and signage, company listing and one full-page color advertisement in exhibitor directory and one conference registration

Silver ($3,500)- one six foot table display, three representatives, company acknowledgements on PowerPoint slides and signage, and company listing and half-page, black and white advertisement in exhibitor directory.

Bronze ($2,500) - one six foot table display, two representatives, company acknowledgements on PowerPoint slides and signage, and company listing in exhibitor directory

Admin

3.Company Representative(s) Attending:

Representative 1 - Name & Email

Representative 2 - Name & Email

Representative 3 - (Silver, Gold & Platinum Only)-Name & Email 

Representative 4 ( Platinum Only) - Name & Email

4.Select Payment

Check (payable to Thomas Jefferson University - Office of CPD)

EFT

Credit Card (please fill out credit card form and email to markiya.fagan@jefferson.edu)

5.Payment Contact

Name

Email Address

Phone Number

*6.Company Description for Exhibitor Directory(Required.)

7.Electrical Requirements

No

Yes - please specify needs

*8.By providing your electronic signature, you are agreeing to the following terms:

• All exhibits must be tabletop or portable in nature.
• Exhibitor activities are restricted to the allocated space at the conference. Distribution of educational/promotional materials by exhibitors is limited to their booth space in the exhibit area. It is not permitted anywhere else in the hall, in conference meeting space, or at the entrances to the conference meeting space.
• Exhibits are intended for informational purposes, products should not be sold on site.
• Photography by exhibitors that includes pictures of the overall conference and/or its attendees is prohibited.
• The purpose of the exhibit is to further the education of meeting attendees through product and service displays and demonstrations. Exhibitor personnel may observe, but must refrain from any participation or recording of any scientific sessions on that company’s behalf.
• The conference is not responsible for the security of exhibitors’ materials.  We suggest that exhibitors leave nothing of value (e.g., laptop computer, audio visual equipment, etc.) unattended at any time in the exhibit hall.
• Payment must be received prior to the start of the conference
• Exhibitor is NOT furnishing commercial support for this conference, Exhibitor is buying exhibit space.

(Required.)