List the Two Names of Your Representatives Who Will Staff Your Exhibit

 REGISTRATION  EXHIBIT INFORMATION Reserve your space. Please fill out & return Exhibit Date: Saturday June 24, 2017 this form, with your check. Or if you prefer, Hotel: Isleta Resort Phone: (505) 848-1999 call in Credit Card number for booth If you require internet access, contact the NMPhA office. (There is payment. an additional charge for this.) Company______Attendance: 250 people expected Name______Profile of attendees: Attending are Pharmacists from all areas of practice as well as other Title______healthcare professionals. Attendees include: Community Pharmacists; Address______Independent Pharmacy Owners; Consultant Pharmacists; Chief Pharmacists; Hospital Pharmacists; Professors and Students from UNM City, State, Zip______College of Pharmacy; Pharmacist Clinicians; New Mexico Board of Telephone______Pharmacy Members and Drug Inspectors and Staff; Certified Nurse List the two names of your representatives who Practitioners; Certified Nurse Midwives; Physician Assistants; Certified Pharmacy Technicians (CPhT); and Pharmacy Technicians. will staff your exhibit. Booth Size & Cost: EARLY BIRD by 5/26/17 8’ x 8’, pipe and drape @ $800 Name______8’x 16’ @ $1200 Address______LATE REGISTRATION after 6/1/17 8’x 8’ @ $900 City, State, Zip______8’x 16’ @ $1300 Name______Booth Assigned: Upon receipt of your exhibit fee you will be listed as an exhibitor in Address______our Annual Convention Program. Booth locations are assigned on a first-paid basis. City, State, Zip______Setup Time: Saturday, June 24, 2017 from 9:00 am - 11:00 am Electrical needed for exhibit? Y N If you are sponsoring a speaker at our Mid-Winter Exhibit Time: 11:00 am - 2:00 pm Meeting or Annual Convention & NMPhA does not Breakdown: Directly following show at 2:00 pm plan to process a grant request from your Drayage: TBD organization, the fee is waived. However, you still need to send in this form! Cost: $800 - $1300. If your company is sponsoring a speaker and NMPhA Program Sponsoring:______is not processing a grant request from your organization, the fee is waived. However, we still need the form. ______Refund Policy: Up to three weeks prior to our Convention a refund, minus a $50.00 Mail or fax form, along with method of administration fee may be obtained. No refunds after Friday, June payment for $800 - $1300 to: 16, 2017. No refunds for no shows! New Mexico Pharmacists Association 2716 San Pedro NE, Suite C Tax ID#: 85-0096044 Albuquerque, NM 87110 Phone: (505) 265-8729Fax: (505) 255-8476  GENERAL INFO New Join us for a fun filled weekend! Mexico The weekend will start with the New Mexico Pharmacists Pharmacy Wholesalers’ Invitational Golf Association Tournament on Friday, June 23, 2017. The www.nmpharmacy.org proceeds from the tournament go to the New Mexico Pharmaceutical Care Foundation (supporting UNM College of Pharmacy activities as well as other areas focusing on pharmaceutical care in New Mexico.) The New Mexico Pharmacists Association is an accredited provider of continuing pharmacy 2017 Annual Convention education. Continuing education programs will be provided all day Saturday and Sunday and are Exhibit Registration & not affiliated with the Golf Tournament. Sponsorship Information The Isleta Resort is located south of the Register & Pay online at Albuquerque International Sunport. The Hotel www.nmpharmacy.org is close to Old Town, Aquarium/Bio Park, the University of New Mexico, the Sandia Peak Tram, the Indian Pueblo Cultural Center, as well as may other points of interest. Experience Southwestern Hospitality with members of the New Mexico Pharmacists June 24, 2017 Association! We welcome you as a part of our 11am – 2pm Annual Convention! Isleta Resort See you in June at our 88th Annual Convention! 11000 Broadway SE www.nmpharmacy.org Albuquerque, NM 87105 June 23 - 25, 2017 (505) 848-1999/ Isleta Resort 11000 Broadway SE (877) 747-5382 Albuquerque, NM 87105 (505) 848-1999/(877) 747-5382 Group Rate: ($119) sgl. or dbl.