Thank you for your intrest in the 2nd Annual Jefferson Sialendoscopy Course. Below is the exhibitor registration form. If you have any questions on concerns, please feel free to call Ariel Levine at 215-955-2477 or email at ariel.levine@jefferson.edu

Company Registration
The information you will provide below is what will be listed in the Exhibitor Directory for this course. If you have any questions regarding this, please reach out to the course planner listed above.
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Please provide the official name of the company being registered
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Please provide the address that will be listed in the Exhibitor Directory
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Please provide the applicable city for the above address
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Please provide the applicable state for the above address
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Please provide the applicable zip code for the above address
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Enter your company description (limit of 250 words) to be included in exhibitor directory distributed to all attendees:
Exhibit Coordination Information
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Please provide the first name of the person coordinating the exhibit (Please note: this will be the name of the person listed in the exhibitor directory)
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Exhibitor Level Selection
Please select your desired exhibitor level below
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Add-Ons
Below are a list of additional add-ons you may purchase with your exhibit. Please note: you must purchase an exhibit level prior to purchasing an add-on
Exhibitor Badges
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Please note: this is for Silver and Gold level exhibitors only.
Please note: This is for Gold level exhibitors only
Electricity and Other Needs
Select Payment
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Agreement
As an Exhibitor in this Continuing Medical Education program, I agree to the following: Exhibitor is NOT furnishing commercial support for this conference, Exhibitor is buying exhibit space. All exhibits must be tabletop or portable in nature. Exhibitor activities are restricted to the allocated space at the conference. Distribution of educational/promotional materials by exhibitors is limited to their booth space in the exhibit area. It is not permitted anywhere else in the hall, in conference meeting space, or at the entrances to the conference meeting space. Exhibits are intended for informational purposes, products should not be sold on site. Photography by exhibitors that includes pictures of the overall conference and/or its attendees is prohibited. The purpose of the exhibit is to further the education of meeting attendees through product and service displays and demonstrations. Exhibitor personnel may observe, but must refrain from any participation or recording of any scientific sessions on that company's behalf. The conference is not responsible for the security of exhibitors' materials. We suggest that exhibitors leave nothing of value (e.g., laptop computer, audio visual equipment, etc.) unattended at any time in the exhibit hall. Cancellation by the Conference Organizers In the event that the Conference would have to be cancelled, the organizers are not responsible for any airfare, hotel, and/or other costs incurred by exhibitors. Sunshine Act The Parties acknowledge and agree that Exhibiting Company may be subject to Section 6002 of the Affordable Care Act, which added Section 1128G to the Social Security Act, and its implementing regulations codified in 42 CFR 402 & 403 (collectively the "Sunshine Act"). Exhibiting companies are solely responsible for collecting any information about actions within their exhibit space that constitutes a payment or transfer of value to a Covered Recipient that is required to be reported under the Sunshine Act.
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