Exhibitor & Sponsorship Application

23rd Annual Fall Conference | November 11, 2017

Section 1: Company Information
*REQUIRED
(Exactly as you wish it to be printed.)
*REQUIRED
*REQUIRED
*REQUIRED
*REQUIRED
*REQUIRED
*REQUIRED

Section 2: Booth Selection
(This is how the name tags should read.)

Section 3: Sponsorship Opportunities

The following opportunities are available for your company to support conference activities.Your support will be recognized in the syllabus, through signage and announcements at the event, and in the Cornhusker Family Physician.

Please check the items below for which you would like to support.  Thank you, in advance, for supporting the NAFP.


Section 4: Authorized Agent and Method of Payment
*REQUIRED
I have read and understand the conditions of this contract. By signing below I am indicating my company’s agreement to abide by the NAFP’s rules and regulations for Fall Conference exhibitors and/or sponsors as the same may be amended from time to time. I accept responsibility for informing all of our representatives of these conditions and for ensuring that they will abide by them also. I further understand the cancellation policy.
*REQUIRED
*REQUIRED
*REQUIRED
Visa MasterCard American Express Discover Diners Club
*REQUIRED
/
*REQUIRED
? Visa®, Mastercard®, and Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.
*REQUIRED
CANCELLATION POLICY

Cancellation of contract to exhibit must be made in writing to the NAFP. If written notice of cancellation is received before September 1, 2017, a full refund less a $100 administration fee will be made for each exhibit booth that is cancelled. A 50 percent refund will be made for cancellations made after September 1, 2017, but before September 30, 2017. No refunds will be made for cancellations received after September 30, 2017, or for no-show exhibitors. All balances must be paid in full before the exhibit date.