2024 Hospital Medicine Intent-to-Exhibit Template

19^th Annual Northwest Regional
Hospital Medicine Conference

Hood River, Oregon

Exhibit Days: September 19-20, 2024

Exhibit Fee:*

Thursday - $1200Friday - $1200Both days - $2000

Method of Payment*

General Information: You will receive a 6 foot exhibit table, with two chairs and, if noted below, electricity to your table. If your display requires more space than the 6 ft. table, please contact the CPD office at doeringl@ohsu.edu. Allocation of exhibit space will be determined by the Division of CPD. Should conditions warrant, the Division reserves the right to cancel this program or exhibit with full refund of the exhibit fee.

The exhibit room is separate from the educational space, as required by the ACCME. All breakfast and break foods, plus coffee, will be set in the exhibit room for maximum exposure to our learners.

Company Name*

Contact Person*

First NameLast Name

E-mail*

Confirmation Email

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Phone Number*

Brief description of the condition or patient-care need your exhibit will highlight, to be printed on the acknowledgments list.*

0/150

Is there a 3rd party company that will issue the check?*

YesNo

Paying Company*

Will the exhibit table be staffed by someone other than the above contact?*

YesNo

On-site representative:*

First NameLast Name

Unknown at this time

E-mail*

! Please email doeringl@ohsu.edu with the name on the on-site representative when it is know.

Will you need an electrical outlet for your display?*

YesNo

Payment by check:

Make check payable to OHSU-CME. Mail to: Oregon Health and Science University | Continuing Professional Development - L602 | 3181 SW Sam Jackson Park Rd. | Portland, OR 97239

Payment by credit card:

Complete the attached Exhibitor Payment form and email to cme@ohsu.edu. 
Payment form password: CPDExhibits

INTENT TO EXHIBIT

19th Annual Northwest Regional Hospital Medicine Conference

Hood River, Oregon

Exhibit Days: September 19-20, 2024

19^th Annual Northwest Regional
Hospital Medicine Conference