2010 Annual Meeting
Exhibitor Registration
Exhibitor Registration
   
  Company Name:   Contact Person: 
  Address:
  City:   State:    Zip:
  Phone:   Fax:    Mobile:
  Admin Email (req):
  Names for Exhibit Badges:     
    
     
  YES, I plan to exhibit at the FSO/HNS- FSFPRS Annual Meeting, November 6-8, 2009 at the Disney's Grand Floridian Resort & Spa in Orlando, Florida. We wish to participate this year at the following support level:
 
 Platinum Patron (up to 4 reps) $3500 PATRON LEVEL BENEFITS
 Gold Patron (up to 3 reps) $2500
 Silver Patron (up to 2 reps) $1500
   No, I cannot display or attend the meeting, but would like my company name to appear in the program as a supporter. Enclosed is my check for $200 for that support.
   We also wish to host/help host the:
Continental Breakfast:  Saturday  Sunday  
Coffee Break:  Friday  Saturday  Sunday
Cocktail Reception:  Friday    
Other:
   We will add the following amount onto our check for that sponsorship: $
  OR
   We will pay the hotel directly for hosting a breakfast, coffee or other event with a credit card.
  Activities
I plan to attend the:

Friday, November 6, 6 - 7:30 pm
 Cocktail reception in the Exhibitor Hall # attending
 
 
  A block of rooms has been reserved at Disney's Grand Floridian Resort & Spa at $255 per night, single or double occupancy. Call 407-824-1383 and book under the Florida Society of Otolaryngology or FSO room block. The room block is released on October 6. .

 
  When you submit this form you will be taken to a payment page to complete this registration.
     
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