AMIA 2020 Exhibitor Application Question Title * Company Name Question Title * Mailing Address Street City State|Province and Postal Code Country Question Title * Contact Information for the Booth Listing Contact Name or Department Company Website Address Email Address Phone Number Question Title * Contact for Booth Arrangments Name Email Address Phone Number Question Title * If You Would Like Your Conference Program Listing to be different from the Above Information, Please List the Changes Here Question Title * Company Information for Website|Program Use (Maximum 50 words) Question Title * Please Attach Your Logo Here JPG, JPEG file types only. Choose File Choose File No file chosen Remove File Please Attach Your Logo Here Question Title * 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 Question Title * Are You Interested in Receiving Sponsorship Information Yes No Done
