Sponsorship & Exhibits Payment Form Sponsorship & Exhibits Payment Form Sponsorship & Exhibits Payment Form This form is for UPDATES. It is to be used if someone from your organization has already completed the form titled: August 4-6, 2023 - 5th Annual Breast Cancer Symposium in the pull-down menu. Select the conference from the pull down. * Please Select... May 2-3, 2024 - 11th Annual Spring to LifeOctober 18-20, 2024 - 6th Annual Breast Cancer SymposiumMay 5-6, 2023 - PAYMENT UPDATE - 10th Annual Spring to LifeAugust 4-6, 2023 - PAYMENT UPDATE - 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 Sponsorship Selections Exhibit Opportunities Bronze = $5,000 Silver = $7,500 Gold = $10,000 Platinum = $12,500 OtherOther S2L Exhibit Opportunities Bronze = $2,750 Silver = $3,750 Gold = $5,750 Platinum = $10,000 Sponsorship Options Bronze = $2,500 Silver = $3,750 Gold = $5,000 Platinum = $10,000 Exhibitor Spotlight Dedicated promotional e-Blast (included in Gold & Platinum)= $1,200 Product Theater = $12,500 Product Theater Online Live Stream Upgrade = $5,000 Representative Registration = $500 SPONSORSHIP DETAILS SPONSORSHIP DETAILS Upgrades BCS SPONSORSHIP UPGRADES Exhibitor Spotlight – Dedicated promotional e-Blast = $1,750 Product Theater Morning Product Theater = $12,500 Lunch Product Theater = $17,500 Evening Product Theater = 12,500 Product Theater Online Live Stream Upgrade Product Theater Online Live Stream Upgrade = $5,000 A live online broadcast stream promoted to the national database of 2,000+ past participants BCS Update Rep Registration Representative Registration = $500 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 NOTE: Only exhibitors are eligible to submit an application for a Product Theater pending approval. 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) 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 * If you are human, leave this field blank. Submit Application Δ
