Prepared By - American Contact Dermatitis Society

contactderm.org

Prepared By - American Contact Dermatitis Society

CONTACT DERMATITIS 2008:BLENDING SCIENCE WITH BEST PRACTICEL’ALLIANCE DU LABORATOIRE ET DE LA CLINIQUEThis agreement is to acknowledge the intention of:SPONSORSHIP APPLICATION FORMCompany Name:Contact:Title:Address 1:Address 2:City and Province/State :Country:Postal Code:Tel:Fax:E-mail: VERY IMPORTANTto participate as:□ A Platinum Sponsor CAD 11,750.00 / USD 10,000.00□ A Gold Sponsor CAD 5,850.00 / USD 5,000.00□ A Silver Sponsor CAD 1,175.00 / USD 1,000.00□ A Bronze Sponsor CAD 585.00 / USD 500.00at the 2008 Contact Dermatitis Conference□ YES, we want a 6 feet table and we will display the following products/services (thisdescription will be included in the Final Program):□ NO, we do not want a display table, but we want to be listed as sponsors with thefollowing product/service description (this description will be included in the FinalProgram):One of our account directors will contact you to further discuss this agreement.Signature:Date:Please fax this form to: +1 (386) 437-4427

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