Jacksonville, Florida

Healogics, Inc.

Jacksonville, Florida

2016 Exhibitor Agreement

Vendor Certification Form

In consideration of its ongoing business relationship with Healogics, Inc. (Healogics), the undersigned Company hereby certifies and acknowledges that:

1. Company is eligible to participate in Federal and State health care programs or Federal and State procurement or non-procurement programs and has not been debarred, suspended or otherwise declared ineligible to participate.

2. Company has never been convicted of any of the following offenses:

a. Program-related crimes;

b. Crimes relating to patient abuse;

c. Felony conviction relating to controlled substances;

d. Or otherwise declared ineligible to participate in Federal health care programs or Federal procurement or non-procurement programs.

3. Company agrees to provide Healogics with written notice in the event of a change in circumstances which makes this certification untrue or inaccurate.

(COMPANY NAME)
(Authorized Representative Signature)
(Name)
(Title)
(Date)

Letter of Agreement between Healogics, Inc. (Healogics) and Exhibitors

All support associated with a CE/CME activity, whether in the form of an educational grant or not, must be given with the full knowledge and approval of Healogics. No other funds from a commercial source shall be paid to the director of the activity, faculty, or others involved with the supported activity.

Commercial Support of CE/CME Defined

CE/CME providers may receive financial and other support from non-accredited commercial organizations that can contribute significantly to the quality of CE/CME activities. The American Medical Association (AMA) / Accreditation Council for Continuing Medical Education (ACCME) and American Nurse’s Credentialing Center (ANCC) have adopted standards for ethical actions in commercial support that Healogics endorses and complies with for all educational activities. Faculty, sponsors, exhibitors and commercial contributors must comply with these standards.

Basic Principles of Commercial Support

1. Healogics is responsible for content, quality and scientific integrity and every other aspect of sponsored CE/CME activities;

2. All organizations must comply with the ANCC Content Integrity Standards for Industry Support in Continuing Educational Activities which is available on the ANCC web page.

3. Education and promotion shall not be mixed by design or in printed material.

4. The audience is entitled to know if funds are supplied by a commercial source, if there is any relationship between a speaker and the commercial source, or if a speaker has a significant relationship with any commercial company;

5. Educational grants may be used for normal expenses in putting on the CE/CME Activity, but may not be used to pay a participant to attend the CE/CME Activity;

6. CE/CME activities must be free of commercial bias for or against any product and will not promote any proprietary interests of a Commercial Interest organization providing financial or in-kind support.

7. Exhibitors

Product-promotion material or product-specific advertisement of any type is prohibited in or during the CE/CME activity. The juxtaposition of editorial and advertising material on the same products or subjects is not allowed. Live or enduring promotional activities must be kept separate from the CE/CME activity. Promotional materials cannot: be displayed obstructing the entry or exit of the CE/CME class room or designated education space; displayed or distributed in the education space at any time (prior, during, or after). Commercial Interests are prohibited from engaging in sales or promotional activities at the CE/CME location outside of the exhibit hall and exhibit times.

8. Commercial supporters of educational activities:

a. Shall not control the assessment of learning needs, determination of objectives, selection or development of content, selection of planners, presenters, faculty, authors and/or content reviewers, selection of teaching/learning strategies and evaluation methods of the activity.

b. May provide funds in the form of unrestricted educational grants to the responsible organization for use in support of the CE/CME Activity.

c. May assist with the printing costs of educational materials.

d. May disseminate information about a CE/CME activity to the medical community when authorized by Healogics.

e. May support social events that do not compete with, or take precedence over, the educational events.

9. Healogics reserves the right to determine activity sponsorship based on compliance with those guidelines.

Activity Name: / ~Essentials of Wound Care and Hyperbaric Medicine
~Nursing Care of the Hyperbaric Patient and Wound Healing
~Introduction to Hyperbaric Medicine and Safety – Tech Track
Date: / February 19, 2016, 4:00 – 7:00 pm

Healogics, Inc.

Jacksonville, Florida

2016 Exhibitor Agreement

Exhibitor

I understand and agree to the Commercial Support and/or Exhibitor terms and conditions of a CE/CME activity as stated above.

Signature / Date
Name
Company Name
Address
City, State, Zip
Phone
Email

Responsible Organization

I understand and agree to the Commercial Support and/or Exhibitor terms and conditions of a CE/CME activity as stated above.

Signature / Date
Name
Company Name / Healogics, Inc. /Learning & Development
Address / 5220 Belfort Road, Suite 130
City, State, Zip / Jacksonville, FL 32256
Phone / 904-446-3549
Email

Healogics, Inc.

Jacksonville, Florida

2016 Exhibitor Agreement

Payment

Level/Options / Gold
($7500) / Silver
($5000) / Bronze
($3000)
3 hours of access to 300+ clinical, physician and operations leadership / ü / ü / ü
Hand Selected Prime Booth Location for the 3 hour vendor event / ü / ü
Name and contact information on the Vendor - Section of Event App viewable for full 2 day event / ü / ü / ü
Pre-event supplied company give away supplied in the Swag Bag / ü / ü
Company Name and Logo on the front of the Swag Bag / ü
Sponsorship Advertisement on the home screen of Event App / ü
Larger booth (2-6 foot tables) with First choice location preference / ü
Market Research – ability to provide 2 questions you would like to hear back from employees and we will provide you with their responses along with general demographic cuts of the data / ü

Check should be payable to Healogics

Indicate in MEMO: ZC004 –Exhibit Fee Leadership 2016

and forwarded with this completed form to:

Attn: Learning & Development

Healogics, Inc.

5220 Belfort Road, Suite 130

Jacksonville, FL 32256

Questions? or (904) 446-3695

Exhibitor Information: (Please completely fill out this page and send with check.)

Indicate level Choice (Gold, Silver, Bronze)
Company Name:
Company Representative(s)
Attending:
Company Product:
Street Address:
City/State
Zip:
Phone: / (o) / (c)
Fax:
Email: