PACEP 2022 Resident Days

PACEP 2022 Resident Days - Exhibitor
Company Name*
Contact Name*

First NameLast Name
Address (Billing)*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number (Billing)*

Area CodePhone Number
Email*
example@example.com
Central Residents Day - August 30, 2022 @ Geisinger, DanvilleWestern Residents Day - September 1, 2022 @ Hilton Garden Inn, PittsburghEastern Residents Day - September 14, 2022 @ University of Pennsylvania, Philadelphia
prevnext( X )
Exhibit$1,300.00

Quantity

Exhibit - All Three Sites$3,000.00

Quantity

Total $0.00
Check (made payable to PACEP)Credit Card (Please call us with your credit card info 877-373-6272 x 101)
NOTE: Checks should be made payable to PACEP as noted above and mailed to:

800 N. Third Street, Suite 408-B

Harrisburg, PA 17102
Signature*

Clear
Signing my name on this application indicates understanding and agreement to comply with all policies, rules, regulations, terms and conditions by PACEP; willingness to abide by the payment policy; aknowledgement of having read the rules and regulations; and agreement that the rules and regulations are an integral and binding part of this contract. This is a legally binding contract, with cancellation at the discreation of the Pennsylvania College of Emergency Physicians.
Today's Date*

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PACEP 2022 Resident Days - Exhibitor