Exhibitor Contract

Company Name:*

Company Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Telephone:*

Please enter a valid phone number.

Email:*

example@example.com

Company's product or service:*

Contact Person:*

How many representatives will be attending:*

12

Name of Representative 1:*

First NameLast Name

Email:*

example@example.com

Name of Representative 2:*

First NameLast Name

Email:*

example@example.com

Company Logo*

Membership Meeting Schedule

Exhibitors can arrive at 5:30pm. Social begins at 6:00pm. Dinner begins at 7:00pm.

Date	Location	Speaker
September 18, 2024	Ardea Country Club	Dr. Michael Hashemian, Common and Uncomon Maxillofacial Infections
November 13, 2024	Hilton Carrilon Park	Dr. Alexander Bendayen, Digital Dentistry
January 15, 2025	Ardea Country Club	Dr. Joe Grimaudo, Sleep Apnea
February 19, 2025	Bon Appetit Restaurant	Dr. Raed Kasem, Practical pathways to Treatmetn of External Root Resorption
March 19, 2025	Dunedin Golf Club	Dr. Austin Belknap, Clinical Oral Pathology
April 16, 2025	Bon Appetit Restaurant	Dr. Larry Lieberman

How many representatives are attending dinner:*

12

Dietary Restrictions:*

Form of Payment:*

CheckCard

Please select which meeting's you wish to attend:*

Payment:*

August 15, 2024

$500.00

September 18, 2024

$350.00

October 16, 2024

$350.00

November 13, 2024

$350.00

January 15, 2025

$350.00

March 19, 2025

$350.00

April 16, 2025

$350.00

Additional MealsMeeting specification required below payment.

$50.00 Quantity

Purchase 10 Drink Tickets

$100.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Which meetings require additional meals (please specify amount of additional meals selected per meeting):*

Make checks payable to:

UPCDA

P.O. Box 611

Brandon, FL 33509

Please verify that you are human

Exhibitor Contract

Membership Meeting Schedule

Exhibitors can arrive at 5:30pm. Social begins at 6:00pm. Dinner begins at 7:00pm.

Date

Location

Speaker

September 18, 2024

Ardea Country Club

Dr. Michael Hashemian, Common and Uncomon Maxillofacial Infections

November 13, 2024

Hilton Carrilon Park

Dr. Alexander Bendayen, Digital Dentistry

January 15, 2025

Ardea Country Club

Dr. Joe Grimaudo, Sleep Apnea

February 19, 2025

Bon Appetit Restaurant

Dr. Raed Kasem, Practical pathways to Treatmetn of External Root Resorption

March 19, 2025

Dunedin Golf Club

April 16, 2025

Bon Appetit Restaurant

Sponsor a Social- $500

Membership Meeting- Booth Space $350