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AMIA 2020 Exhibitor Application
Company Name
Mailing Address
Street
City
State|Province and Postal Code
Country
Contact Information for the Booth Listing
Contact Name or Department
Company Website Address
Email Address
Phone Number
Contact for Booth Arrangments
Name
Email Address
Phone Number
If You Would Like Your Conference Program Listing to be different from the Above Information, Please List the Changes Here
Company Information for Website|Program Use (Maximum 50 words)
Please Attach Your Logo Here
Choose File
No file chosen
Please let us know how booth payment will be sent so that we can send you payment details. Payments can be made in two parts, with the second payment due no later than December 31, 2020. Booth costs are $1200 for Institutional Members and $1500 for non-members
Check
Direct Deposit
Credit Card
Notes
Are You Interested in Receiving Sponsorship Information
Yes
No
