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Exhibitor ProsPEctus - Pacific Dermatologic Association

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2013 <strong>Exhibitor</strong> Application and Contract<br />

65th Annual Meeting | August 14-18, 2013<br />

Company: ____________________________________________________________________________________<br />

Address: _____________________________________________________________________________________<br />

City: ___________________________________________________ State: ________ Zip: _____________________<br />

Country: ____________________________ Phone: ____________________________________________________<br />

Fax: _______________________________ E-mail: ____________________________________________________<br />

Contact: (person to whom contract and meeting information should be sent)<br />

Name: __________________________________________________ Title: _____________________________________________________<br />

On-site Main Contact: (person who would be listed in the program as a post-event contact for doctors attending the meeting)<br />

Name: __________________________________________________ Title: _____________________________________________________<br />

Booth Registration:<br />

Each booth registration includes: one (1) 8’ x 10’ booth, an ID sign, four (4) exhibitor staff registrations, a pre-show attendee list and a company description in the conference program.<br />

Booth Registrations (Qty) x US $1,650 each $<br />

Additional Exhibit Reps (Qty) x US $100.00 each $ Total enclosed: $<br />

Booth Selection:<br />

Using the numbers listed on the enclosed Floor Plan, please provide your 1 st through 4 th choices of booth space. Please note that booths are assigned on a first-come, first-served<br />

basis, based upon receipt of registration and payment.<br />

1st choice: __________ 2nd choice: __________ 3rd choice: __________ 4th choice: __________<br />

Exhibit Staff: (please include names and titles of additional booth staff on a separate sheet of paper)<br />

Name: __________________________________________________ Title: _____________________________________________________<br />

Name: __________________________________________________ Title: _____________________________________________________<br />

Name: __________________________________________________ Title: _____________________________________________________<br />

Name: __________________________________________________ Title: _____________________________________________________<br />

Description of Products and Services: (1 paragraph, 250 character limit)<br />

Note: Descriptions received after July 1, 2013 may not be included in the on-site conference program. Please email description to pda@hp-assoc.com or attach a sheet of paper,<br />

with description to this registration form.<br />

We/I agree to abide by all regulations set forth in the accompanying brochure that is made part of this contract and to all conditions under which exhibit space in the The Palace<br />

Hotel is leased to the PDA. No refund of any deposit will be allowed for voluntary cancellation after July 1, 2013. Initial space assignment begins June 1, 2013.<br />

Authorized Signature: __________________________________________________________ Date: ___________________________________<br />

Payment Information q Check #: _____________ -or- q VISA q MasterCard q AMEX<br />

Card #: _______________________________________________________________________ Exp. Date: _____________________________<br />

Signature: ________________________________________________________________________________________________________<br />

PLEASE COMPLETE AND MAIL, FAX or SCAN & email WITH PAYMENT:<br />

<strong>Pacific</strong> <strong>Dermatologic</strong> <strong>Association</strong>, 575 Market Street, Suite 2125, San Francisco, CA 94105 | ph: (888) 388-8815 | fax: (415) 764-4915 | pda@hp-assoc.com

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