MOA 115th Annual Convention Exhibitor & Sponsor Registration

MOA 115th Annual Convention Exhibitor & Sponsor Registration
Company Name
Company Logo

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Company Website
Contact Name

First NameLast Name
Contact Email
example@example.com
Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsor/Exhibitor Booth Information
*Non-Profit/Government/Public Health Association booths are subject to MOA approval
Sponsorship Selection

Other
Exhibit/Sponsorship Total
Payment Information
An invoice will be sent to you within 2 business days via the MOA's Bill.com account. Please pay via the link by credit card, bank transfer, or check within 30 days of the Annual Convention.
Preferred Method of Payment
*A processing fee will be added to credit card transactions
Check Number
Check can be made payable to:

Maine Osteopathic Association
PO Box 1488
Warrenville, IL 60555
Event/Booth Representative 1

First NameLast Name
Event/Booth Representative 2

First NameLast Name
If you would like to bring additional Representatives beyond the 2 included with your exhibit table, please list their names below. Additional representative registration will be billed at $100/person.
Products or Services Organization Represents
Companies/Products you do not wish to have in close proximity. We will do our best to honor requests but booth assignments are purview of MOA staff.
Do your representatives have any accessibility or other accommodation requests? (including Dietary restrictions or food allergies we should be aware of)
Exhibitor And Sponsor Attendee Handout Information

All exhibitors and sponsors will have the opportunity to be featured in a handout distributed to all attendees. Please provide your contact information, headshot (if desired), and small writeup no more than 100-150 words in length. Handouts will also be available for online registrants.

*Please have all information submitted no later than May 6th, 2026 to be included in attendee handout*
Handout Contact Name

First NameLast Name
Handout Contact Email
example@example.com
Handout Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Handout Company Description (100-150 words)
Handout Headshot

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By completing this form, I am authorized and agree to participate in the indicated activity of the Maine Osteopathic Association. I commit my company to the above financial obligation. Payment due: May 6th, 2026
Should be Empty: