Sponsor Registration

Saturday, 4 of September of 2010

Sponsor Registration

Payment Information for Sponsor Registration

If you or your organization are currently sponsoring the 2010 MPRC and would like to attend; please complete the online registration form below. ALL representatives are required to register for the Conference separately. If you or your organization are not a MPRC Sponsor and would like to become one please visit the "Becoming a Sponsor" link on the "Sponsor" page located within this website. Once you have donated as a sponsor you must return to this page to register to attend the conference.

Payment Fee Type:
Complimentary registration with DIAMOND LEVEL sponsorship - up to 6 reps. ($0.00)

Complimentary registration with PLATINUM LEVEL sponsorship - up to 4 reps. ($0.00)
Complimentary registration with GOLD LEVEL sponsorship - up to 2 reps. ($0.00)
Registration for DIAMOND, PLATINUM and GOLD LEVEL sponsorships exceeding comp rep allotments ($130.00)
Registration with SILVER LEVEL sponsorship ($130.00)
Registration with COPPER LEVEL sponsorship ($130.00)
Registration with ASSOCIATE LEVEL sponsorship of $500 - $999 ($130.00)
Registration with ASSOCIATE LEVEL sponsorship of $0 - $500 ($260.00)

Amount:

First Name:

Last Name:

Middle Name:

Company

Company Street Address

Street:

City:

State:

Zip:

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

E-Mail:

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

Sponsor Registration