2023 Annual Meeting Exhibitor Registration 12 HiddenAdministrationCompany InformationCompany Name(Required) Billing Contact Name(Required) First Last Credentials (MD, DO, etc.) Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Billing Contact Phone(Required)Billing Contact Email(Required) Sponsorship Levels & OptionsYour 2022 Package includes the following: Verbal recognition at the meeting, print acknowledgements in the conference e-syllabus and WSNS website, posters at the sponsored event, and complementary reception, breakfast, breaks, and lunch for two representatives. Additional representatives are welcome and an additional $300.00 Plus additional benefits as outlined below: Diamond Sponsorship ($5,000.00) Conference RegistrationYour company name & logo printed on conference name badges, listed on the website, electronic syllabus and acknowledged on a poster and at introductions. This comes with a tabletop display Speaker SponsorYour company provides an honorarium for a speaker (approved by the WSNS board) This comes with a display-table top. Your company name & logo printed on a conference poster and acknowledged at introductions. This comes with a table top display Gold Sponsorship ($4,000.00) Lunch SponsorYour company is acknowledged with a poster and podium announcement that the lunch is supported by your organization/company. This comes with a display-table top. Silver Sponsorship ($3,000.00) Breakfast SponsorYour company is acknowledged with a poster and podium announcement that the break is supported by your organization/company.This comes with a display-table top. Bronze Sponsorship ($2,000.00) Morning Coffee break sponsorYour company is acknowledged with a poster and podium announcement that the break is supported by your organization/company. This comes with a display-table top. Afternoon Coffee break sponsorYour company is acknowledged with a poster and podium announcement that the break is supported by your organization/company. This comes with a display-table top. Tabletop display only ($1,000.00) Display only At the meeting, to encourage attendee traffic and attendee participation, we will have a raffle or passport type activity. In the past years, the “Passport” has worked well and was enjoyed by attendees. If you have a raffle item you would like to include and present to an attendee, please let me know.Non-Profit My organization is a non-profit Sponsorship Level(Required) Diamond Sponsorship - $5,000.00 Gold Sponsorship - $4,000.00 Silver Sponsorship - $3,000.00 Bronze Sponsorship - $2,000.00 Tabletop display only - $1,500.00 HiddenAdditional Representative at Booth 3rd Representative - $300.00 HiddenNumber of Reps OptionsElectrical Outlets Required? Yes No How Many?(Bring your own extension cords)Please enter a number less than or equal to 3.RepresentativesName of Representative(s)(Required)Please fill in as much as you have available. If you don't yet know the name, please fill in "TBD" If you don't need the space, please fill in "N/A"First NameLast NameCredentials (MD, PhD, etc.)Email Add RemovePaymentPayment Type(Required) Credit Card Check Check Number(Required) Coupon Total Upon completing the form and clicking "submit", you will be directed to PayPal to complete the meeting exhibitor agreement payment. A PayPal account is not necessary to make a payment. INQUIRIES: Contact the WSNS Office at 206-956-3635 or send emails to admin@washingtonneurology.org.CAPTCHA Δ
