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2007 Conference

WSDA
2033 Sixth AVe., Ste. 1100
Seattle, WA 98121

 kad@wsma.org

 

 

 

WASHINGTON STATE DERMATOLOGY ASSOCIATION
PACIFIC NORTHWEST DERMATOLOGICAL
 74th ANNUAL SCIENTIFIC CONFERENCE
The Coeur d’Alene Golf and Spa Resort, Coeur d’Alene, Idaho
July 12-15, 2007

EXHIBITOR APPLICATION

 1.    COMPANY NAME:___________________________________________________
      EXHIBIT MANAGER:___________________________________________________
      ADDRESS:___________________________________________________________
      CITY _______________________ STATE ___________ ZIP CODE:___________
      TELEPHONE:(______)___________________Fax:(_____)___________________
      E-Mail: ___________________________________________________________

2.    NAME OF LOCAL REPRESENTATIVE:_________________________________
      ADDRESS:___________________________________________________________
      CITY _______________________ STATE ___________ ZIP CODE____________
      TELEPHONE:(______)__________________Fax:(______)___________________
      E-Mail: ___________________________________________________________

3.    NAME OF COMPANY REPRESENTATIVE(S) THAT WILL STAFF YOUR BOOTH:

      1. _____________________________  2. ______________________________

      3. _____________________________  4. ______________________________

4.    NAME OF FIRMS YOUR COMPANY WOULD PREFER NOT TO BE LOCATED
ADJACENT TO,  OR ACROSS FROM:

      ________________________________  _________________________________

      ________________________________  _________________________________

5.    CHECK APPROPRIATE BOOTH SPACE REQUESTED:  U.S. FUNDS only.

                q  ONE EXHIBIT BOOTH -  $1,000.00       q  TWO EXHIBIT BOOTHS - $1,800.00

 6.    SPONSORSHIP:          q PLATINUM $10,000 and up   q GOLD $7,000-$9,000
                                  q SILVER $4,000-$5,000   q BRONZE $2,000-$3,000
      Each of these categories includes a FREE exhibit booth display.

7.    THE EXHIBIT PRACTICES AND REGULATIONS  ARE PART OF THE AGREEMENT.

8.    RETURN THIS FORM AND YOUR PAYMENT TO:
                     Washington State Dermatology Association
                     2033 Sixth Ave., Suite 1100, Seattle, WA 98121 

9.    VALUE OF YOUR EXHIBIT: $_________           Tax ID # 94-3167911

Requested by: _________________________         _________________________

                      (Signature)                                          (Title)

╔════════════════════════════════════════════════════════╗
║ FOR OFFICE USE ONLY                                                                                                ║
║  Date Received: _______ Amount: _______ Check Number: _______________               ║
║                                                                                                                                            ║
╚═════════════════════════════════════════════════════════╝

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