I/We agree to pay with application 50% of the total fee for booth space and pay the balance due by January 31, 2014. Applications received after January 31, 2014, must be submitted with full payment. Incomplete applications, unapproved exhibitor’s applications, and applications received without deposits will not be processed. This application and contract may be cancelled at any time by the College with written notice. ACM 2014 Exhibition Dates: April 28-30, 2014 • Early Bird Application Deadline: May 8, 2013 PLEASE PRINT OR TYPE Company or Organization Name (This name will appear in the Exhibit Guide.) Booth Contact (All exhibit material will be forwarded to contact at address below.) Title Mailing Address (No P.O. Boxes, please.) City State Zip Country Telephone Number Fax Number Email Address Are you a new exhibitor? M Yes M No If not, under what name did you last exhibit?_________________________________________________________ Organization description, please check all that apply: M Association/Medical/Society M Laser and Laser Supplies M Photographic, X-ray, Imaging, and Ultrasound M Computer Software/Hardware Technology M Market Research Equipment M Diagnostic Equipment/Systems/Kits M Maternity Products/Clothing Supplies M Publishing/Books M Education/Training Materials M Medical Equipment M Recruitment (Physician) M Electronic Medical Records Software (EMR) M Medical Supplies/Gloves/Gowns M Skin Care Procedures M Financial Services/Leasing/Insurance M Office Equipment/Supplies/Lights/ M Skin Care Products M Food/Nutritional Products M Furniture/Gowns M Surgical Instruments/Supplies M Government Agencies M Personal Hygiene Products M Other__________________________ M Laboratory Services/Cytology/Hematology M Pharmaceutical Please indicate the desired booth size. (Must be in increments of 10 feet.) Booth size: ________ x ________. Each inline booth is $3,200 and each corner space is $3,500. Total cost of exhibit space: $__________________. Booth(s) Request (please indicate booth choices in order of preference): 1st ________________ 2nd ________________ 3rd ________________ 4th ________________ 5th _________________ 6th _________________ List up to three competitors that you do not wish to be placed within close proximity (we cannot guarantee that you will not be placed in proximity with a com_petitor): 1) _____________________________________ 2) ______________________________________ 3) ______________________________________ The Application shall constitute a non-revocable offer by Exhibitor until such time as the College notifies Exhibitor that it has assigned exhibit space. Exhibitor shall only promote, exhibit or display products/services that are approved by the College. By signing the Application, Exhibitor agrees to abide by all of the policies, rules and regulations contained in the Application, the 2014 ACM Exhibitor Prospectus, the 2014 ACM Exhibitor Service Manual, and any correspondence from the College or its agent(s) to the Exhibitor, its staff, officers or agents. Together these documents shall comprise the contracts between the College and the Exhibitor. The College shall have the right to shut down any exhibit or bar future exhibition participation if, in the College’s opinion, the exhibitor disregards or refuses to observe The College’s or convention center’s requirements and rules, or it is determined that the exhibit is offensive or not in keeping with the professionalism or standards or standard of the practice of Ob/Gyn, or written or verbal instructions. Signature Printed Name Date If paying by check, please make payable to ACOG 2014 ACM. If paying by credit card, please complete all of the information below to ensure that your credit card is accepted and your payment is approved. Credit Card Type: M Visa M MasterCard M American Express Amount to charge: $__________________ Credit Card #: ____________________________________________________ Exp. Date:______________________ CVN #:_______________________ Printed Name on Card (as it appears): ________________________________ Payment Authorized by:____________________________________________ www. a c o g . o r g / a c m 62nd Annual Clinical Meeting McCormick Place Convention Center • Chicago, Illinois • April 26-30, 2014 FOR ACOG USE ONLY Natl. ID #:_________________________ Batch:____________________________ Date Received:______________________ Total Due: $________________________ Deposit: $_________________________ Check #:__________________________ Balance: $_________________________ Batch:____________________________ 2nd Payment:_______________________ Amount: $_________________________ Check #:__________________________ Balance: $_________________________ Booth(s) Assigned:___________________ Booth Size:________________________ Date:_____________________________ ACOG Authorized Signature of Acceptance:______________ Date:_____________________________ Priority Points:______________________ MAIL TO: ACOG 2014 ACM, ATTN: Exhibits Management, 409 12th Street, SW, Washington, DC 20024-2188, (202) 314-2333 or acmexhibit@acog.org AACOPG ExhPibit ALpplIicaCtion Aand CTontrIacOt N