APT Conference - Exhibitor/Sponsor Registration

2023 Arizona Perinatal Trust Annual Conference Sponsor and Exhibitor Registration

Contact Person*

First NameLast Name

Contact Person E-mail*

Contact Person Phone Number*

Area CodePhone Number

Payment Method*

CheckCredit Card

Exhibitor/Sponsor Type - Credit Card Payment*

Nonprofit Community Partner (1 Attendee)$500.00

(e.g. IHS, health departments and small community organizations)

Exhibitor (1 Attendee)$1,000.00

(e.g. Individual Hospitals, Medical Equipment Companies, etc.)

Sponsor (2 Attendees)$2,500.00

Exhibitor/Sponsor Type - Check Payment*

$500 - Nonprofit Community Partner (1 Attendee) - (e.g. IHS, health departments and small community organizations)$1000 - Exhibitor (1 Attendee) - (e.g., Individual Hospitals, Medical Equipment Companies, Universities)$2500 - Sponsor (2 Attendees)

Affiliation*

Health System, Organization, Hospital, Company

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Attendee *

First NameLast Name

Attendee Credentials

Attendee RN License #

Attendee E-mail*

How would you like your name printed on your badge?*

Lunch Choice

VegetarianNon-vegetarian

2nd Attendee (Sponsors Only)*

First NameLast Name

2nd Attendee Credentials

2nd Attendee RN License #

2nd Attendee E-mail*

How would you like your name to be printed on your badge*

Exhibit Details

If you have specific needs that are not covered in the Exhibitor Prospectus, please contact apt@azperinatal.org. Additional fees may apply.

Will you be conducting a raffle?*

NoYes

Do you need an electrical outlet in addition to the mobile phone bank provided?*

Yes, I have equipment required for my demonstration - $25 feeNo, I will use the phone charging station provided by the venue - No fee

Please upload your logo here.

Browse Files

Please indicate how you will submit your organization's logo:*

Will email a logo at a later dateWe exhibited in 2022, so you may use the logo on fileAll set, I uploaded it!

When you click "Submit Registration" you will be redirected to the PayPal login.

IF YOU HAVE a PayPal account, login and complete your payment.

IF YOU DO NOT HAVE a PayPal account, select the button, on the bottom of the PayPal login form, labeled "Pay with Credit or Debit Card."

IF YOU WANT TO PAY BY CHECK, scroll up and select Payment Type "Credit Card."

When you click "Submit Registration" you will receive an email with mailing instructions for your check.

No refunds will be issued for Exhibitors whole fail to occupy their space. Should you have any questions about your registration you can email kathleen@azperinatal.org.