Maine Society for Respiratory Care
    



2017 Exhibitor Packet
Click Here! 

How to Pay
Fill out the form below to pay via PayPal or credit card.

Please mail all payments to:

Cynthia Carlton
157 Cottage Road
Windham, ME 04062

The Maine Event 2017
Online Exhibitor Registration

Check each box as it pertains to you. 

Please reference the 2017 Exhibitor Packet for more information!.

We will email you an electronic invoice 
We accept Visa, MasterCard, American Express, Discover or PayPal.
 
Refund requests must be in writing to amandaalbee@gmail.com and must be received by the MeSRC by April 14, 2017.  A fee of 15% will be deducted from the refund to cover processing.  No refunds will be made after April 14, 2017.

Company Name: *  
Company Phone:  
Contact Person: *  
Contact Person Phone:  
Email: *  
Address:
City:
Zip Code: (5 digits)
Rep Name #1: *
Rep #1 AARC #:  
Rep Name #2:  
Rep #2 AARC #:  
Rep Name #3 ($85.00):  
 Rep #3 AARC #:  
Rep Name #4 ($85.00):  
Rep #4 AARC #:  
   
   Yes, I need Electricty!
   No, I do not need Electricty!
   
   
             
   
 

                               Additional Exhibitor Support

 I will help sponsor a coffee break for $300.00
   I will help sponsor a physician speaker for $500.00
   I will help sponsor hors d'oeuvres for $300.00
   I will help sponsor a non-physician speaker for $250.00
   I will help sponsor the entertainment (band) for $250.00
   I will help sponsor the Exhibitor game for $100.00
   I wold like to donate an item to the silent auction.
   
 

                                   Corporate Partnerships

   I would like to become a Platinum Corporate Partner for $2500.00
   I would like to become a Gold Corporate Partner for $1800.00
   I would like to become a Silver Corporate Partner for $1200.00
   I would like to become a Bronze Corporate Partner for $850.00
   
Silent Auction Item:  
   
   
   
  I have read and understand the guidelines outlined by the MeSRC Exhibitor Registration Packet 2016 for the Maine Event at Spruce Point and agree to comply by them.
Electronic Signature Required: *  
   
Comments:

 

     



   
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