If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Vendor Company Name * Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Contact Person Email * Phone Cell Phone Fax Do you require electricity? Yes No You are hereby agreeing to be a vendor for the SGANP 5th Annual Conference on November 4, 2017. The vendor fee is $300 if paid before July 1, 2017 or $350.00 after July 1, 2017. Vendor fees can be paid online or by check. All payments must be received by October 30, 2017. The conference is expected to host over 100 healthcare professionals. Please return ASAP to hold a booth, only accepting 40 vendors. Participation in the event includes one table and two chairs located inside the vendor area. All vendors are responsible for bringing and removing all materials from their designated booth. Registration for the conference is from 6:30am-‐7:20am. Conference starts at 7:20 am. All vendors must wear name badges to identify themselves to be permitted in the conference. Vendors will be allowed to set up the morning of the conference starting at 6AM and remain until 3PM. SGANP is not responsible for any property damage or liable for any accidents. CANCELLATION POLICY All vendor fees are non-refundable. Representative #1 Name Representative #2 Name Vendor Contact Information Vendor Contact Signature
