Sponsorship & Exhibits Payment Form Sponsorship & Exhibits Payment Form Sponsorship & Exhibits Payment Form Select the conference from the pull down. * May 5-6, 2023 – 10th Annual Spring to Life August 4-6, 2023 – 5th Annual Breast Cancer Symposium If you are paying for more than one conference, please submit the payments separately. Exhibiting Company Name: Exhibiting Company Name: * Exhibiting Company Contact: Exhibiting Company Contact First Name * Exhibiting Company Contact Last Name * Exhibiting Company Contact Email * Exhibiting Company Contact Phone * Exhibiting Company Coordinator Exhibiting Company Coordinator First Name Exhibiting Company Coordinator Last Name Title Exhibiting Company Coordinator Email Exhibiting Company Coordinator Phone Booth Representative 1: Booth Representative First Name Booth Representative Last Name Booth Representative Title Booth Representative Email Booth Representative Phone Booth Representative 2: Booth Representative 2 First Name Booth Representative 2 Last Name Booth Representative 2 Title Booth Representative 2 Email Booth Representative 2 Phone Booth Representative 3: Booth Representative 3 First Name Booth Representative 3 Last Name Booth Representative 3 Title Booth Representative 3 Email Booth Representative 3 Phone Booth Representative 4: Booth Representative 4 First Name Booth Representative 4 Last Name Booth Representative 4 Title Booth Representative 4 Email Booth Representative 4 Phone View 2023 Agenda View 2023 Agenda Sponsorship Selections Exhibit Opportunities Bronze = $5,000 Silver = $7,500 Gold = $10,000 Platinum = $12,500 S2L Exhibit Opportunities Bronze = $2,500 Silver = $3,750 Gold = $5,000 Platinum = $10,000 SPONSORSHIP DETAILS SPONSORSHIP DETAILS Upgrades BCS SPONSORSHIP UPGRADES Exhibitor Spotlight – Dedicated promotional e-Blast (included in Gold and Platinum) = $1,200 Product Theater = $15,000 Product Theater Online Live Stream Upgrade = $5,000 S2L Upgrades Exhibitor Spotlight - Dedicated promotional e-Blast (included in Gold & Platinum)= $1,200 Product Theater = $12,500 Product Theater Online Live Stream Upgrade = $5,000 Billing Information Please Select * Pay Via Check Pay Via ACH/Wire Transfer Pay Via Credit Card NOTE: When the Credit Card form below is completed and submitted, the payment will be processed immediately through Stripe, the credit card processor. Make Checks Payable to: myMedEd, Inc. 518 S. IL Route 31 #194 McHenry, IL 60050 TAX ID: 82-4893155 First Name - Billing * (Name on card) Last Name - Billing * (Name on card) Payment Amount * $ Purchase Notes * Address - Billing * Address - Billing Address - Billing Address - Billing Address - Billing Address - Billing State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Address - Billing Credit Card - Billing * If you are human, leave this field blank. Submit Application Δ
