2022 Potpourri Exhibitor Prospectus Download a copy of the prospectus Please complete the information below to reserve your spot. Company Name (as you would like it to appear on signage and marketing)* Product/ Service Promoting Company URL Primary Contact Name (to whom ALL information will be sent)* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Contact Phone*Primary Contact Email* Information for Representatives Attending TablePlease indicate the name of the representative(s) EXACTLY as it should appear on their name tag. 4 representatives are allowed for Premium Sponsorships. 2 representatives all for all exhibit levels.Representative #1 Name* First Last Representative #2 Name First Last Representative #3 Name First Last Representative #4 Name First Last Booth InformationBooths are assigned according to exhibit level and venue layout. The best effort will be made to separate major competitors when assigning table locations. This may not be guaranteed as each venue differs in size of exhibit space.Please list your top two competitors if applicable. Premium Sponsorships $15,000 Friday Evening Resident Poster and Attendee Social $15,000 Saturday Business and Awards Luncheon $15,000 Saturday Evening Themed Social Exhibit Levels $6,000 Gold $4,500 Silver $3,000 Bronze $1,500 Basic Marketing Sponsorships $3,000 Tote bag $2,500 Hotel key cards $2,000 Break sponsor $1,500 Charging station $1,500 Notepad and pens $1,000 Lanyards Optional $750 Table Add On $75.00/ Day electrical access $50/ Day internet $50 Additional name badge Total owed*Terms and Conditions• EXHIBITOR agrees to abide by ACCME Standards for Commercial Support as stated at www.accme.org: SCS 4.2: “Product-promotion material or product-specific advertisement of any type is prohibited in or during CME activities. The juxtaposition of editorial and advertising material on the same products or subjects must be avoided. Live (staffed exhibits, presentations) or enduring (printed or electronic advertisements) promotional activities must be kept separate from CME.” “Live, face-to-face CME, advertisements and promotional materials cannot be displayed or distributed in the educational space immediately before, during or after a CME activity. Providers cannot allow representatives of Commercial Interests to engage in sales or promotional activities while in the space or in the place of the CME activity.” • EXHIBITOR may distribute promotional materials at their exhibit space only. Distribution of pharmaceuticals or product samples is prohibited. • All commercial support associated with this activity will be given with the full knowledge of the PROVIDER. No additional payments, goods, services or events will be provided to the course director(s), planning committee members, faculty, joint sponsor, or any other party involved with the activity. • Completion of this agreement represents a commitment and payment is due and collectible by the SPECIFIED DATE in the exhibitor prospectus unless otherwise agreed upon by the PROVIDER. PROVIDER reserves the right to refuse exhibit space to EXHIBITOR in the event of nonpayment. • PROVIDER agrees to provide exhibit space and may acknowledge EXHIBITOR in activity announcements. • PROVIDER reserves the right to assign exhibit space or relocate exhibits at its discretion. • If the event is not conducted, PROVIDER will refund the entire exhibit fee received to EXHIBITOR. If this agreement is cancelled by EXHIBITOR less than thirty (30) days in advance of the Activity Date, a cancellation fee of $250 shall be immediately due and payable to PROVIDER.Consent* I agree to the terms and conditions Δ