2017 Sponsor & Exhibitor Registration
Sponsorship deadline is Friday, June 8, 2017 for your name to be included in the conference brochure.
Registration and payment for exhibitors is due at time of registration to confirm your sponsorship, exhibit, or advertisement space.
City, State, Zip
Please select from the following (Early Bird Pricing)
Please select from the following
Extras (please check all that apply)
Additional exhibit space: $350
Extra printed edition of the syllabus: $25
Wireless internet: free (this service is only intended for light exhibitor use, such as checking emails, browsing the internet, etc.)
Choose the location of your exhibit booth. . Booths currently available for sponsors and exhibitors: 16, 32-34, 36, 37.
List top 3 choices
Click here for diagram
How many staff will be at your booth? (Please note that there can be a maximum of two people at each booth the day of the conference. If you'd like extra people to be at the booth, they will need to pay the regular admission price for the conference.)
Exhibitor #1 Name
Exhibitor #1 Email
Exhibitor #2 Name
Exhibitor #2 Email
If you plan on contributing to the conference raffle, please indicate the item here. Enter N/A if you do not wish to contribute to the conference raffle.
Check payable to HealthSource Solutions
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