NJAFP 2022 FamMed Forum Exhibit-Sponsorship Registration FormPlease enable JavaScript in your browser to complete this form.Company Name *Website / URLContact Name *Email *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeExhibit OptionsExhibit Display - $ 1,100.00Double Exhibit Display - $ 2,500.00Non-Profit Display - $ 800.00Sponsorship OptionsAttendee Lunch - Exhibit Floor - $ 3,000.00Attendee Breakfast - Exhibit Floor - $ 2,000.00Attendee Break - Exhibit Floor - $ 1,000.00Product/Service Theatre - Exhibit Floor - $ 2,500.00Resident Knowledge Bowl Event - $ 1,500.00Awards Ceremony Sponsor - $ 1,500.00Awards Ceremony Reception - $ 2,000.00Conference Bags - $ 3,000.00Conference Program Ad - Half Page - $ 300.00Conference Program Ad - Full Page - $ 550.00Conference Bag Insert - $ 250.00TOTAL$ 0.00Discount/Deferred Credit2020 Deferral CreditNJAFP/ACPNJ Combo 10% Discount (apply discount only to Exhibit display total, not sponsorships)Please contact Sandi Selzer (sselzer@njafp.org) for more information about the NJAFP/ACPNJ discountEnter Revised Total After Above DiscountPayment Options:CheckElectronicEXHIBIT DISPLAY INFORMATIONDisplay Location ChoicesPlease see Exhibit Hall floor plan on the website and enter top 3 location choices above.Exhibit Representative #1 NameExhibit Representative #1 EmailExhibit Representative #2 NameExhibit Representative #2 EmailSubmit
