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DNA Helix

26th ANNUAL SERGG MEETING
EXHIBITOR REGISTRATION FORM

SERGG, Inc. accepts payment by check (made payable to “SERGG, Inc. ”) or by credit card (Visa, MasterCard, Discover, American Express) via PayPal. 

Please fill in the following information:

* Required in order to process your application

*Contact Persons First Name:

 
Middle Initial:
 

*Contact Persons Last Name:

 

*Contact Persons E-mail address:

 

*Confirm E-mail address:

 

Company Name:

 

*Address Line 1:

 
Address Line 2:
 
Address Line 3:
 

*City:

 

*State:

 
*Zip:
 
*Country:
 

*Phone:

 
[format: 555-555-1234]
Fax:
 
Company Website URL:
 
Rep to be present at meeting:
 
Brief description of products to be exhibited (40 words or less):
 

 

*I would like:
Platinum Sponsor (buffet dinner or wine and cheese reception) - $5000
Gold Sponsor (lunch or breakfast)- $2500
Silver Sponsor (fellow/resident/student to attend meeting) - $1500
Exhibit Space (commercial) $1000
Exhibit Space (non-profit) $500

I will need electrical services
Please describe your needs:

*I have read the Exhibitor Fact Sheet and agree to these terms. Instead of signature, please enter your initials in the box below, and then click submit.


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