Exhibitor Sponsor Registration - GulfCoastDentalConference.org

1. Registration

Company

Number of Years This Company Has Exhibited at the Alabama Dental Association/Gulf Coast Dental Conference

Number of Years This Company Has been a Corporate Sponsor for the Alabama Dental Association/ Gulf Coast Dental Conference

First Name

Last Name

Title

Mailing Address

City

State

Zip

Cell Phone

this email address will receive all correspondence regarding the exhibit and sponsorship

2. Personnel Information

Booth Personnel 1

Booth Personnel 2

Booth Personnel 3

Booth Personnel 4

3. Booth Information

Total Booths Desired

1st Choice

2nd Choice

3rd Choice

4th Choice

Companies we wish to be next to

Companies we DO NOT wish to be next to

Briefly describe the equipment, products, or services to be featured

Booth Theme

4. Payment Selection for Sponsors and Exhibitors

Choose Exhibit Booth or Sponsorship Level

Add-on Sponsorship

If you are choosing an add-on sponsorship such as lanyards - select here

ONLY Gold, Platinum, and Diamond Sponsors have the choice of paying via check. All other sponsors and exhibitors must pay via credit card below.

Gold, Platinum and Diamond sponsors please check the box if you are choosing to pay by check instead of credit card. Your sponsorship is not confirmed until the check has been received.

I am mailing a CHECK

I, , hereby agree to the terms and conditions of this contract.

5. Payment

First Name

Last Name

Card Number

Exp Date

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Completion of this form is considered a signed application and contract for exhibiting at the 2024 Gulf Coast Dental Conference. Applications that are not properly completed, or that fail to include payment in full will be returned unprocessed. Whenever possible, space will be allocated according to the exhibitor's choice, but space will be determined by the Gulf Coast Dental Conference in a way as to produce the most advantageous grouping of exhibits. With an electronically submitted or signed paper contract, applicants agree to abide by all provisions, rules and regulations as published on gulfcoastdentalconference.org.

a payment receipt will be emailed to the email address above