Sponsorship & Exhibits Payment Form Sponsorship & Exhibits Payment Form Sponsorship & Exhibits Payment Form Select the conference from the pull down. * June 23-26, 2022 - American Medical Forum September 23-25, 2022 – Breast Cancer Symposium November 17-20, 2022 - American Medical Forum 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 * Virtual Trade Show Booth Coordinator (if applicable) Virtual Trade Show Booth Coordinator (if applicable) Same as Exhibiting Company Contact Virtual Trade Show Booth Coordinator First Name Virtual Trade Show Booth Coordinator Last Name Virtual Trade Show Booth Coordinator Email Virtual Trade Show Booth Coordinator Phone Virtual Trade Show Booth Coordinator First Name Virtual Trade Show Booth Coordinator Last Name Virtual Trade Show Booth Coordinator Email Virtual Trade Show Booth Coordinator Phone Exhibiting Company Coordinator Exhibiting Company Coordinator First Name Exhibiting Company Coordinator Last Name Title Exhibiting Company Coordinator Email Exhibiting Company Coordinator Phone Virtual Trade Show Booth Coordinator: Virtual Trade show Booth Coordinator First Name Virtual Trade show Booth Coordinator Last Name Virtual Trade show Booth Coordinator Email Virtual Trade show Booth 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 View 2022 Agenda View 2022 Agenda Sponsorship Selections LIVE IN PERSON Exhibit Opportunities Bronze = $5,000 Silver = $7,500 Gold = $10,000 ONLINE ONLY Virtual Booth Opportunities Bronze = $2,000 Silver = $3,500 Gold = $5,000 Bronze Thursday 06/23 = $1,500 Friday 06/24 = $1,500 Saturday 06/25 = $1,500 Entire Conference - 4 days (includes exhibit space 06/23 - 06/26) = $4,500 Bronze Thursday 10/06 = $1,500 Friday 10/07 = $1,500 Saturday 10/08 = $1,500 Entire Conference - 4 days (includes exhibit space 10/06 - 10/09) = $4,500 Bronze Thursday 11/17 = $1,500 Friday 11/18 = $1,500 Saturday 11/19 = $1,500 Entire Conference - 4 days (includes exhibit space 11/17 - 11/20) = $4,500 Silver Thursday 06/23 = $2,000 Friday 06/24 = $2,000 Saturday 06/25 = $2,000 Entire Conference - 4 days (includes exhibit space 06/23 - 06/26) = $6,000 Silver Thursday 10/06 = $2,000 Friday 10/07 = $2,000 Saturday 10/08 = $2,000 Entire Conference - 4 days (includes exhibit space 10/06 - 10/09) = $6,000 Silver Thursday 11/17 = $2,000 Friday 11/18 = $2,000 Saturday 11/19 = $2,000 Entire Conference - 4 days (includes exhibit space 11/17 - 11/20) = $6,000 Gold Thursday 06/23 = $2,500 Friday 06/24 = $2,500 Saturday 06/25 = $2,500 Entire Conference - 4 days (includes exhibit space 06/23 - 06/26) = $7,500 Gold Thursday 10/06 = $2,500 Friday 10/07 = $2,500 Saturday 10/08 = $2,500 Entire Conference - 4 days (includes exhibit space 10/06 - 10/09) = $7,500 Gold Thursday 11/17 = $2,500 Friday 11/18 = $2,500 Saturday 11/19 = $2,500 Entire Conference - 4 days (includes exhibit space 11/17 - 11/20) = $7,500 **There is a 4th ½ Day of the conference being held Sun. If the entire conference is selected, the 4th Day is included.** FOR DETAILED SPONSORSHIP AND EXHIBIT OPPORTUNITIES - CLICK HERE Upgrades SPONSORSHIP UPGRADES Exhibitor Spotlight Email = $1,200 OFFSITE Product Theater Permission = $7,500 ONSITE Product Theater = $15,000 Upgrades Exhibitor Spotlight Email = $1,750 Virtual Exhibit Booth for Virtual Attendees = $2,000 Print and Online Registration Bag Insert = $1,000 Door Drop Fee = $1,250 Product Theater = $10,000 Video Stream of Product Theater to Virtual Attendees = $3,000 Monthly Newsletter Ad (1-Month) = $1,000 Monthly Newsletter Ad (12-Months) = $5,000 NOTE: A stand-alone product theater or speakers program will not be supported by the conference if permission has not been obtained by the conference organizers. Company must be exhibiting to participate in any of the upgrades. To be eligible for the Product Theater option, the company must be sponsoring at a combined amount of $4,000 including upgrades. FOR DETAILED SPONSORSHIP AND EXHIBIT OPPORTUNITIES - CLICK HERE Billing Information Please Select * Pay Via Check Pay Via ACH/Wire Transfer Pay Via Credit Card 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
