Potpourri Exhibitor & Sponsor Registration Form

Company and Primary Contact Information

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 State ZIP Code

Primary Contact Phone*

Primary Contact Email*

Information for Representatives Attending Table

Please 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 (Platinum Sponsorships)

Four representatives included for Platinum Sponsorships. Additional representatives named for all other exhibit levels will be considered an additional exhibitor pass and invoiced accordingly.

First Last

Representative #3 Email

Representative #4 Name (Platinum Sponsorships)

Four representatives included for Platinum Sponsorships. Additional representatives named for all other exhibit levels will be considered an additional exhibitor pass and invoiced accordingly.

First Last

Representative #4 Email

Company Description*

Please share a brief description of your company and what you are about for inclusion in our digital exhibitor directory.

Booth Information

Booths 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 the size of exhibit space.

Please list your top two competitors.

Disco- Platinum Sponsorships

Exhibit Levels

Meal and Snack Sponsorships

Marketing Sponsorships

Custom Package Idea

Please share a brief description of your custom marketing package idea.

Advertising Sponsorships

Registration Brochure Ad Copy Due March 1. On-Site Brochure Ad Copy Due July 19.

Optional Add Ons

Table Add On

If you will need an additional table or would like to add a table with your marketing or meal sponsorship, please indicate here. Advertising sponsorships are not eligible for a table add on.

Price: $750.00

Electrical Access 1-Day

If you will need electrical access for both days of the conference, please make the quantity 2.

Price: $75.00

Breakfast and Snacks – One Person

Please add the number of representatives who will need breakfast and snacks. Breakfast and Snacks are included for Disco-Platinum, Rock-Gold, and Funk-Silver exhibit levels.

Price: $50.00

Additional Exhibitor Pass

All Exhibitors will be expected to be registered for an exhibitor pass. Exhibitor, Bronze, Silver, and Gold levels include two exhibitor passes and Platinum level includes four passes. If you expect to have more representatives attend the conference than your exhibit level includes, please add the number of additional badges you will need here.

Price: $50.00

How do you plan to pay?*

Please note: Credit Card charges will include a 3.6% processing fee.

Check

Credit Card

ACH (Automated Clearing House)

Credit Card Processing Fee

We will contact you to complete your credit card transaction.

Price: $0.00

Total

This total is an estimate based on how you have filled this form and may be adjusted by chapter staff before you are invoiced.

Terms and Conditions

Consent*

• 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.

• PROVIDER reserves the right to cancel agreement if it is found that EXHIBITOR has practices that do not align with the mission and values of the PROVIDER.

• 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.

I agree to the terms and conditions

2024 Cenla Potpourri Exhibitor Registration

Company and Primary Contact Information

Information for Representatives Attending Table

Booth Information

Optional Add Ons

Terms and Conditions

Pin It on Pinterest