Exhibitor Registration

Thursday, 11 of March of 2010

Exhibitor Registration

Payment Information for Exhibitor Registration

***DEADLINE FOR EXHIBIT REGISTRATION IS APRIL 15, 2010*** When purchasing exhibit space, it is recommended that each rep. attending the MPRC register separately and pay a $100.00 registration fee. If your organization prefers to pay registration fees for each rep. and exhibit space rental fees in one transaction; please select the appropriate payment fee type below and list the names of EACH rep. attending the MPRC from your institution in the space provided at the bottom of this page.

Payment Fee Type:
Exhibitor Registration Fee ($100.00)

6 ft. Skirted Table and 1 Reg. Fee ($750.00+100.00) ($850.00)
6 ft. Skirted Table and 2 Reg. Fees ($750.00+200.00) ($950.00)
6 ft. Skirted Table and 3 Reg. Fees ($750.00+300.00) ($1050.00)
8X8 Booth and 1 Reg. Fee ($1000.00+100.00) ($1100.00)
8X8 Booth and 2 Reg. Fee ($1000.00+200.00) ($1200.00)
8X8 Booth and 3 Reg. Fee ($1000.00+300.00) ($1300.00)

Amount:

Description of Exhibit

Middle Name:

Exhibit Space Rental:
First Name:

Last Name:

E-Mail:

Phone (###-###-####):

Exhibitor Company:

Street:

Company Street Address

City:

State:

Zip:

Please list additional representatives from your organization that will be attending the conference. (if none, please put N/A or none)

Payment Options

PAY BY PAPER CHECK :

Please make checks payable to: Midwest Pharmacy Residents Conference

Mail a copy of your registration form and payment to:

Dana J. Price
Office Coordinator, Pharmacy/Pathology Services
THE NEBRASKA MEDICAL CENTER
988138 Nebraska Medical Center
Omaha, NE 68198-8138

HOTEL ACCOMMODATIONS AT THE CONFERENCE:

You are responsible for your own hotel arrangements. To make hotel reservations please see the “Lodging and Travel” page on our website.

mprc

Exhibitor Registration