Sponsorship & Exhibits Payment Form Sponsorship & Exhibits Payment Form Sponsorship & Exhibits Payment Form Select the conference from the pull down. * Please Select...May 2-3, 2024 - 11th Annual Spring to LifeJune 12, 2024 and/or June 19, 2024 - University of Illinois Cancer Center Summer CME Series If you are paying for more than one conference, please submit the payments separately. Exhibiting Company Name: Exhibiting Company Name: * Company Representative(s) First Name Last Name Email Phone Select all that apply: Attending the conference Organizer/contact for the exhibit Organizer/contact for the product theater plus1 Add minus1 Remove Organization plans to attend and exhibit: May 2, 2024 May 3, 2024 May 2 &3, 2024 Sponsorship Selections Bronze = $1,750 Session 1: June 12, 2024 – Lung, Head, Neck and Colorectal Cancers Session 2: June 19, 2024 – Breast and GU Silver = $2,750 Session 1: June 12, 2024 – Lung, Head, Neck and Colorectal Cancers Session 2: June 19, 2024 – Breast and GU Gold = $4,750 Session 1: June 12, 2024 – Lung, Head, Neck and Colorectal Cancers Session 2: June 19, 2024 – Breast and GU Platinum = $6,000 Session 1: June 12, 2024 – Lung, Head, Neck and Colorectal Cancers Session 2: June 19, 2024 – Breast and GU S2L Exhibit Opportunities Bronze = $2,750 Silver = $3,750 Gold = $5,750 Platinum = $10,000 SPONSORSHIP DETAILS VIEW AGENDA SPONSORSHIP DETAILS EXHIBITOR INFORMATION AGENDA Upgrades Exhibitor Spotlight – Dedicated promotional e-Blast = $1,500 Session 1: June 12, 2024 – Lung, Head, Neck and Colorectal Cancers Session 2: June 19, 2024 – Breast and GU Product Theater = $7,500 Session 1: June 12, 2024 – Lung, Head, Neck and Colorectal Cancers Session 2: June 19, 2024 – Breast and GU Product Theater Online Live Stream Upgrade = $2,500 Session 1: June 12, 2024 – Lung, Head, Neck and Colorectal Cancers Session 2: June 19, 2024 – Breast and GU Faculty Dinner = $7,500 Session 1: June 12, 2024 – Lung, Head, Neck and Colorectal Cancers Session 2: June 19, 2024 – Breast and GU S2L Upgrades Exhibitor Spotlight - Dedicated promotional e-Blast (included in Gold & Platinum)= $1,500 Product Theater = $12,500 Thursday Evening Faculty Dinner Sponsorship = $7,500 Product Theater Online Live Stream Upgrade = $5,000 A live online broadcast stream promoted to the national database of 2,000+ past participants Describe the sponsorship update that is being submitted and why. * 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) Subtotal: * $ Payment Amount * $ Purchase Notes * Address - Billing * Address - Billing Address - Billing Address - Billing Address - Billing Address - Billing State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Address - Billing Credit Card - Billing * Email * Submit Application If you are human, leave this field blank. Δ
