2023 Crescent City Potpourri Exhibitor Registration 2023 Potpourri Exhibitor Registration "*" indicates required fields Step 1 of 4 25% Company and Primary Contact InformationCompany 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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 #1 Email* Representative #2 Name First Last Representative #2 Email Representative #3 Name (Premium Sponsorships) First Last Representative #3 Email Representative #4 Name (Premium Sponsorships) First Last Representative #4 Email 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. Coral Reef (Premium) SponsorshipsPremium Sponsorship$15,000 Friday Resident Poster Presentation and Attendee Social$15,000 Saturday Luncheon Sponsor$15,000 Saturday Evening Themed SocialExhibit LevelsExhibit Level$6,000 Dolphin$4,500 Sea Turtle$3,000 Sea Horse$1,500 ClamMarketing SponsorshipsMarketing Sponsorship$3,000 Tote Bag Sponsor$2,500 Conference App and Wifi$2,000 Break Sponsor$1,750 Conference Themed Item Sponsor$1,500 Charging Station Sponsor$1,000 Lanyard SponsorOptional Add OnsTable Add On Quantity Price: $750.00 Quantity If you will need an additional table or would like to add a table with your marketing sponsorship, please indicate here. Electrical Access 1-Day Quantity Price: $75.00 Quantity If you will need electrical access for both days of the conference, please make the quantity 2. Breakfast and Snacks - One Person Quantity Price: $50.00 Quantity Please add the number of representatives who will need breakfast and snacks. Breakfast and Snacks are included for Coral Reef (Premium), Dolphin, and Sea Turtle level sponsors.Additional Name Badges Quantity Price: $50.00 Quantity If you will need additional name badges for representatives, please add the number of badges you will need here.How do you plan to pay?* Check Credit Card Please note: Credit Card charges will include a 3.6% processing fee.Credit Card Processing Fee Price: $0.00 We will contact you to complete your credit card transaction.Total Terms and ConditionsConsent* I agree to the 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. Δ