Arizona Ambulatory Surgery Center Association (AASCA)

Vendor Display Booth Registration Company Name: Company Product Type:

Contact person: Website:

Contact cell number: Email address:

Do you have a 10’ display/backdrop?: Yes No *We need to know this so we can make sure to place the larger displays along the wall. Rep(s) Attending: (2 reps are included in the exhibit fee) Name: Email Address:

Name: Email Address: Do you have any door prizes?: (We will coordinate announcements/giveaways with you to maximize your exposure)

AV/Power: *The AASCA will pay for WiFi in the ballroom. For all other AV needs, contact: Saúl Losolla @ [email protected] | fax: 480.596.7046 Exhibit Booth – EARLY BIRD (before May 16) ($850) Exhibit Booth – EARLY BIRD (after May 16) ($950) Additional Rep ($200) Marketing Insert Included in Registration Packet ($250) Platinum Sponsorship ($5,000) Gold Sponsorship ($4,000) Silver Sponsorship ($3,000) Bronze Sponsorship ($2,000) Total Amount Due: Please email or fax your application to: Evelyn Bloomhart, AASCA [email protected] | Tel: 503.409.2984 | Fax: (888) 295-2340 Thank you for your support!