Office of Continuing Education and Public Service . the University of Illinois at Chicago

UIC University of Illinois at Chicago College of Medicine Department of Pediatrics, Division of Neonatology SPECIALTY REVIEW IN NEONATOLOGY/PERINATOLOGY February 6-11, 2008, Holiday Inn Chicago Mart Plaza, Chicago http://www.conferences.uiuc.edu/NeonatologyReview CORPORATE SPONSOR/EXHIBITOR INFORMATION

The UIC College of Medicine, Department of Pediatrics, Division of Neonatology, invites corporate sponsors and exhibitors to participate in the 2008 offering of Specialty Review in Neonatology/Perinatology. Please use this form to indicate your preferred level of participation. Feel free to contact the course manager if you have questions or need additional information in order to confirm your request (contact information provided at bottom of page 2).

COMPANY NAME:

PART I: REQUESTED CATEGORY OF PARTICIPATION BELOW, PLEASE INDICATE THE CATEGORY OF PARTICIPATION REQUESTED — CORPORATE SPONSOR (INCLUDING THE OPTION EXHIBIT SPACE), OR EXHIBIT SPACE ONLY.

A. CORPORATE SPONSOR Commercial support agreement documents, as required by the UIC College of Medicine and sponsors in conjunction with educational grant commitments, will addressed as part of the confirmation process. PLEASE INDICATE LEVEL OF SPONSORSHIP REQUESTED: Official Sponsor ($10,000 and above): $ THIS LEVEL IS LIMITED TO ONE SPONSOR. In addition to highest level of recognition in the course website and syllabus, this level of sponsorship includes complimentary exhibit space and participation of representatives. Additional forms of recognition can be explored, on request.

Primary Sponsor ($5,000 – $9,999): $ In addition to prominent recognition as a major sponsor, this level of sponsorship includes complimentary exhibit space and participation of up to two representatives. The charge for an additional representative is $100 per day. Additional forms of recognition can be explored on request.

Sponsor ($3,000 – $4,999): $ In addition to prominent recognition, this level of sponsorship includes complimentary exhibit space and participation of one representative. The charge for an additional representative is $100 per day.

PLEASE INDICATE WHETHER YOU WILL REQUIRE EXHIBIT SPACE: Exhibit Space Requested: Check here to request an exhibit table. Please indicate preferred exhibit days below: Wednesday (2/6) Thursday (2/7) Friday (2/8) Saturday (2/9) Sunday (2/10) Monday (2/11) No Exhibit Space Requested.

B. EXHIBIT SPACE ONLY Exhibit space is available at a rate of $400 per day. Exhibit fees allow for the participation of one representative on exhibit days. The charge for an additional representative is $100 per day. Please indicate preferred exhibit days below: Wednesday (2/6) Thursday (2/7) Friday (2/8) Saturday (2/9) Sunday (2/10) Monday (2/11) Cancellations/Refunds: Notice of exhibit space cancellation must be received in writing. A cancellation fee of $400 will be assessed for notices received by January 15. No refunds will be issued for requests received after that date.

CONTINUED Page 2: Sponsor/Exhibitor Information Form Specialty Review In Neonatology/Perinatology ● February 6-11, 2008 ● Holiday Inn Chicago Mart Plaza, Chicago

PART II: COMPANY IDENTIFICATION AND CONTACT INFORMATION COMPANY IDENTIFICATION―AS IT SHOULD APPEAR IN PROGRAM MATERIALS

COMPANY IDENTIFICATION ― AS IT SHOULD APPEAR IN COURSE MATERIALS Company Name: City: State: Web Site Address:

SPONSOR CONTACT

Name: Title: Mailing Address (street): City: State: Postal Code: Phone: Fax: E-mail:

PART III: EXHIBIT INFORMATION — SKIP THIS SECTION, IF YOU DO NOT PLAN TO EXHIBIT. Unless otherwise arranged, exhibitors will be provided with one six-foot table or equivalent floor space. Access to one standard electrical outlet will also be provided at no additional charge. Arrangements for additional and/or special services, and any associated costs, are the responsibility of the exhibitor. As needed, hotel contact information will be provided for confirming special services and related costs. PRODUCT DESCRIPTION — Please provide, below or as separate attachment, a brief description of product(s) to be exhibited:

ELECTRICAL REQUIREMENTS Standard outlet. # requested: Exhibitors requesting multiple outlets will be notified of additional charges, as applicable. No electrical service required. OTHER/SPECIAL REQUESTS:

PART IV: ON-SITE REPRESENTATIVES

(1) Name: Title: Mailing Address (street): City: State: Postal Code: Phone: Fax: E-mail:

(2) Name: Title: Mailing Address (street): City: State: Postal Code: Phone: Fax: E-mail: PLEASE FORWARD INFORMATION FOR ANY ADDITIONAL REPRESENTATIVES.

NO PAYMENT IS DUE AT THIS TIME An invoice will be issued, confirming balance due and payment instructions. Commercial support agreement documents, as required by UIC College of Medicine and sponsors in conjunction with educational grant commitments, will likewise be confirmed and addressed as part of this process. CONTACT US Return completed form (via E-mail attachment, as possible), and direct any questions to: Jane Whitener, Program Manager, UI Conferences and Institutes [email protected] ● Phone: 773-271-0223 ● Fax: 773-271-1214