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Continuing Education

bullet EXHIBITORS AND SPONSORS

bullet 2009 Pain Conference Exhibitor Registration Form

Online Exhibitor registration is now available for the 2009 Pain Conference. This conference will be held on Thursday, October 15, 2009, at the Inn of St. Johns in Plymouth, MI.

Please complete and submit the following form. Exhibitor space is limited - Reserve early!

Name

Title

Company Name

Address

City

State

ZIP/Postal Code

E-mail Address

Phone

The exhibitor's fee is payable by check or credit card. Please complete the following and indicate your preferred method of payment. Exhibitor tables will be released if payment is not received by September 1, 2009. Thanks!

Pay By Check
Pay By Credit Card

bulletExhibitor Status: Each exhibitor will be provided a 6-foot white linen-covered table, and includes parking and lunch for one representative from your company.

Yes, I would like to participate as an Exhibitor ($450)

Number of additional representatives? ($35/each)

Names of additional representatives?

Electrical outlet required

Special Meal Accommodations?

Please make a note of who the special meal is requested for.

Other Comments or Concerns

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