Payment for FADONA's 35th Annual Convention Product Theaters
Please note: A signed application is required.
Host Company Name:
*
Contact Name:
*
Contact Title:
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
-
Area Code
Phone Number
Fax Number:
-
Area Code
Phone Number
Email:
*
example@example.com
Event Coordinator
Company Name:
*
Contact Name:
*
Contact Title:
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
-
Area Code
Phone Number
Fax Number:
-
Area Code
Phone Number
Email:
*
example@example.com
Time Slots* Preferred: Select your 1st or 2nd choice (complete separate applications if applying to host more than one program). *Time slots are subject to change.
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( X )
1-Hour Lunch Presentation: Monday, March 21, 12-1 p.m.
$
2,750.00
1-Hour Dinner Presentation: Monday, March 21, 7-8 p.m.
$
2,750.00
1-Hour Breakfast Presentation: Tuesday, March 22, 8-9 a.m.
$
3,250.00
1-Hour Lunch Presentation: Tuesday, March 22, 11:50 a.m.-12:50 p.m.
$
4,350.00
1-Hour Dinner Presentation: Tuesday, March 22, 7-8 p.m.
$
4,950.00
1-Hour Breakfast Presentation: Wednesday, March 23, 8-9 a.m.
$
3,250.00
1-Hour Lunch Presentation: Wednesday, March 23, 1-2 p.m.
$
5,000.00
1-Hour Breakfast Presentation: Thursday, March 24, 8-9 a.m.
$
2,800.00
Total
$
0.00
Program Information
Program Title:
Product/Research being highlighted:
Significance to LTC/relevance to current data or market:
Program Description for use in FADONA promotional materials (brief):
Name of proposed speaker (please email CV/resume/brief bio if possible to sbellotti@fadona.org):
Submit
Should be Empty: