ABSAME Exhibit Application Form

Company:_____________________________________________________________________

Title for Exhibit Booth Sign: (Limited to 36 characters, including spaces):
_____________________________________________________________________________

Contact Name:_________________________________________________________________

Mailing Address (please do not use P.O. Box):________________________________________

_____________________________________________________________________________

Phone: _______________________________  Fax: __________________________________

EMail Address:_______________________________________________________________

Exhibit Booth Fee:  __ Full Exhibit,  $500 for each 8' table
                                            Number of tables:_______  (Please note that if you request more than one table, we will assume that you wish to have contiguous table space.)
                              ___ Combined Book Exhibit,  $100

Total Enclosed:_________

__ Check Enclosed (US Funds) __Payment by credit card (MasterCard or Visa)

Card Number:  ______________________________ Exp:________

I authorize ABSAME to bill my credit card for above indicated charges:

Signature: __________________________

We reserve the right to deny any organization space to exhibit. If this occurs, payment will be promptly returned.

____ I am sending literature to Copper to be distributed to conference attendees

Please check one category that most appropriately describes the product or services for your exhibit. ABSAME will group similar exhibits together in the exhibit hall. If your exhibit cannot be classified in one of the listed categories, please check "other."

 _____ Medical Education Software         _____ Pharmaceutical Company
 _____ Medical Education Hardware       _____ Medical Equipment & Supplies
 _____ Publishing                                      _____ Management Consultant
 _____ Student Support Services              _____ Other (please describe)___________________