Marketing Agreement Company Name Please print EXACTLY as name should appear in program, for representative name badges, and on all signage. Name First Last Title Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneFaxEmail Website MARKETING & VISIBILITY OPPORTUNITIESSPONSORSHIP INCLUDES: 1 Standard Booth which may be upgraded to a Priority Booth for an additional $500. Networking Happy Hour — $7,500 Anesthesia Jeopardy — $5,500 Door Drop — $5,000 + production Welcome Reception — $4,500 Lunch in Exhibit Hall — $3,500 Charging Station— $2,500 (+ production) Key Cards — $3,000 + production Breakfast Symposium Program Ad- Full Page/Back Cover Product NameTotal $0.00 Would you like to upgrade from Standard Booth to Priority Booth for an additional $500?NoYesPriority Booth Price: BOOTH ASSIGNMENT:Booths will be assigned at the sole discretion of show management and will be based on the date of request and consideration of competition. There are a limited number of priority booths available. No specific booth guarantees will be made until payment is received.HiddenON-SITE REPRESENTATIVES:Marketing & Visibility Opportunity fees include full registration and all food functions for four representatives. Additional representatives may register for $200 each. Please list all attending representatives below. A fee of $25 per change will be assessed for all name changes or additions submitted to FSA after April 22, 2022.Hidden1. Hidden2. Hidden3. Hidden4. Your signature on this application indicates that you understand and agree to comply with all the policies, rules, regulations, terms, and conditions contained in the Exhibitor Prospectus for the Florida Society of Anesthesiologists (FSA) and have read the rules and agree to distribute them to those involved with your tabletop. METHOD OF PAYMENTBooths will not be assigned until payment is made in full. Payment not made in full 30 days prior to Annual Meeting forfeits your participation.Payment MethodCredit CardCheckPlease send the payment to: FSAHQ, Attn: Meeting Sponsorships Dept. MAIL: 11300 W Olympic Blvd., Suite 600, Los Angeles, CA 90064 | FAX: 310-437-0585 | EMAIL: [email protected]Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name
