2021 Exhibitor Application Form

Exhibitor Information
Please indicate company information exactly as it should appear in all official publications.
Company Name*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Phone*
Company Website*
Contact Information
Pre-Show Contact Name*
First Last
Pre-Show Contact's Title
Pre-Show Contact Phone*
Pre-Show Contact Email*
Exhibit Reservation
Included in your exhibit fee are 8’ high background drape, 3’ high side drape, one (1) 7” x 44” one-line identification sign (company name and booth number), one (1) 6’ draped table, two (2) side chairs, and one (1) wastebasket. The exhibit hall will be carpeted. Additional items may be purchased in your exhibitor kit that will be sent to you.
Booth Space Options*
Payment Method*
- Credit Card
- Check (Please send invoice)
Total
$0.00
We prefer not to be in proximity to the following companies (please list no more than two):
Booths will be assigned at the sole discretion of show management and will be based on the date that the Application is received and consideration of competition. Floor plan will be provided. No specific booth guarantees will be made until payment is received.
Please make checks out to:
American Head & Neck Society
11300 W. Olympic Blvs, Suite 600
Los Angeles, CA
90064
Credit Card*

American Express
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Exhibitor Agreement*
- I agree to the statement below.
I the undersigned, apply for technical exhibit space at the AHNS 10th International Conference on Head and Neck Cancer to be held July 22-25, 2021 at the Hyatt Regency Chicago, Illinois. I agree to accept the conditions, rules, regulations, terms and policies in the Exhibitor Prospectus which form part of this agreement.
Email
This field is for validation purposes and should be left unchanged.

Exhibitor Information

Contact Information

Exhibit Reservation

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