Sponsorship Registration
Fall Conference 2026. (October 24)
Sponsor Contact Information
Company Name
Name and Contact Information of Main Point of Contact
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Donation Details
Sponsorship Tier
Title Sponsor $12,000 (Only One Available - Confirm With Society Before Payment)
Diamond Partner $7500
Platinum Partner $5000
Evening Reception Sponsor $5000
Exhibitor Partner $2500
Breakfast Product Theater $9000
Extra Exhibitor Passes $200 Per Badge (Limit One Additional Per Sponsorship)
Other
If you are remitting sponsorship payment by check - please indicate below.
Sponsorship Amount
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( X )
USD
Description
Payment Methods
Debit or Credit Card
ACH Bank Transfer
Sponsorship Purpose
Event Sponsorship
Program Sponsorship
Other
Mailing Address for Payment by Check
Louisiana Dermatological Society: 2270 Eliza Beaumont Lane, Baton Rouge, LA 70808
Additional Comments
Attendee Full Name
First Name
Last Name
Attendee Email Address
example@example.com
Attendee Company
Attendee Full Name
First Name
Last Name
Attendee Email Address
example@example.com
Attendee Company
Attendee Full Name
First Name
Last Name
Attendee Email Address
example@example.com
Attendee Company
Attendee Full Name
First Name
Last Name
Attendee Email Address
example@example.com
Attendee Company
Attendee Full Name
First Name
Last Name
Attendee Email Address
example@example.com
Attendee Company
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