2024 PAMED HOD Exhibitor Registration

Company Name*

(write name as it should be displayed in materials)

Contact Name*

First NameLast Name

Contact Phone*

Please enter a valid phone number.

Contact Email*

All information pertaining to the meeting will be sent to this email address .

Upload Logo*

Brief Company Description*

Company URL*

Registration Type*

Exhibitor ($1,750)Non-Profit Exhibitor ($750)PAMED Premier, Platinum, or Gold Partner (paid annual sponsorship)PAMED Silver Partner ($1,000)PAMED Family (Internal)Community Breakfast Sponsor ($5,000)Boxed Lunch Sponsor ($5,000)Friday PAMED Social Sponsor ($5,000)Hotel Key Card Sponsor ($5,000)

Upload Tax Determination Letter (501c3 Documentation)*

Rep Name(s)*

Exhibit table includes up to (2) on-site reps.

Do you need access to electricity at your table?*

YesNo

Number of people attending Friday PAMED Social

Max of (2)

Number of Tables Needed*

Number of Easels

IT Needs

If you need additional equipment other than your own laptop, please describe your needs above. Your department will incur any additional fees associated.

Additional Setup Requests (location or configuration of tables)

Balance Due

Item	Quantity	Price	Total
Exhibit Table - 2024 HOD	1	$1750	$1750

Make Check payable to Pennsylvania Medical Society

Mail to: