PNWD 88th Annual Scientific Conference Exhibitor Registration Pacific Northwest Dermatological 88th Annual Scientific Conference October 7-9, 2022 Suncadia Resort Cle Elum, WA Please complete the form below to exhibit at the PNWD 88th Annual Scientific Conference Or Maximize Your Presence … Take Advantage of these Exclusive Support Opportunities! PNWD 88th Annual Scientific Conference Meeting Packages Include The Following: Verbal recognition at the podium Complimentary exhibit space Print acknowledgement of support on posters, the PNWD e-syllabus, and WSDA website Electronic list of attendees prior to the conference to promote visits to your booth Four vendor ticket packages with sponsorship ribbons and access to the Saturday Night Dinner EXCLUSIVE SUPPORTER OPPORTUNITIES AVAILABLE: GOLD SUPPORTER - $7,000 (each) WELCOME RECEPTION(purchased) SATURDAY DINNER WIFI SPONSOR SILVER SUPPORTER $5,000 BRONZE SUPPORTER $4,000 (each) COFFEE BREAK – Friday(purchased) COFFEE BREAK – Saturday(purchased) COFFEE BREAK – SundayHiddenAdministrativeUnique IDCompany Name HiddenBooth Number Website Primary Contact InformationPrimary Contact Name* First Last Credentials Primary Contact Title Primary Contact Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Contact PhonePrimary Contact Email* Exhibitor RegistrationExhibit Type* Exhibitor Booth - $3500 - $3,500.00 Bronze Support - $4000 - $4,000.00 Silver Support - $5000 - $5,000.00 Gold Support - $7000 - $7,000.00 Quantity of Booths*Please enter a number from 1 to 3.Gold Support Options* Welcome Reception (1 Available) Saturday Dinner (1 Available) WiFi Sponsor (1 Available) Silver Support Options* Saturday Breakfast (1 Available) Sunday Breakfast (1 Available) Bronze Support Options*There are no options available for this field.Two booth representatives are included with your exhibit package. Extra booth reps are $250 each.Optional - Extra Booth RepsNumber of extra booth reps1 extra booth rep - $250 - $250.002 extra booth reps - $500 - $500.00Exhibit Space InformationExhibit space will be assigned based on level of sponsorship, exhibit location purchased, followed by first come basis.Product/Service to be DisplayedPlease indicate companies, if any, you desire NOT to be located adjacent to (i.e. competitor) Primary Booth Representative Contact(This information will be published and distributed to attendees)Primary Booth Representative Information is the same as Primary Contact Primary Booth Rep Name* First Last Crendentials Primary Booth Rep Title Primary Booth Rep Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Booth Rep PhonePrimary Booth Rep Email* Representatives Staffing Your BoothRep #2 Name First Last Rep #3 Name First Last Rep #4 Name First Last The Welcome Reception and Family DinnerOptional - Adult Guests - $60/PersonNumber of guests1 adult guest - $60.00 - $60.002 adult guests - $120.00 - $120.003 adult guests - $180.00 - $180.004 adult guests - $240.00 - $240.00The Welcome Reception and Family Dinner are complementary to exhibitors. Adult guests are welcome at $60/per person. Guests 12 years and younger are free.PaymentTOTAL $0.00 Payment Type* Credit Card Check Invoice Check Number Check Payment Date Month Day Year CREDIT CARD American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Δ