"*" indicates required fields AdministrationDate MM slash DD slash YYYY Company InformationOctober 28, 2023 Seattle Science Foundation Please complete the form below to exhibit at the 2023 Annual MeetingCompany Name Website Primary ContactPrimary Contact Name First Last Primary Contact Job Title Primary Contact Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Contact PhonePrimary Contact Email* Primary Booth RepresentativePrimary Booth Rep information Same as Primary Contact information Primary Booth Rep Name First Last Primary Booth Rep Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Booth Rep PhonePrimary Booth Rep Email Booth Rep #2 Name First Last Booth Rep #2 Email Booth Rep #3 Name First Last Booth Rep #3 Email Additional booth representatives beyond two are $150 each.Additional Booth Representative* Price: Number of Additonal Representatives012Booth Rep #4 Name First Last Booth Rep #5 Name First Last Product/service to be displayedPlease indicate companies you prefer NOT to be located adjacent to (i.e. competitor) Add RemoveExhibitor Packages GOLD SPONSORSHIP, $10,000: STANDARD SIZE EXIBITOR BOOTH & 20 MIN CADAVER LAB DEMO SILVER SPONSORSHIP, $2500: STANDARD SIZE EXIBITOR BOOTH, 10 MIN PRESENTATION (7 MIN ORAL PRESENTATION/3 MIN Q & A) BRONZE SPONSORSHIP, $1500: STANDARD SIZE EXIBITOR BOOTH ONLY Exhibitor Levels* Gold Sponsorship - $10,000.00 Silver Sponsorship - $2,500.00 Bronze Sponsorship - $1,500.00 Coupon Payment Type Credit Card Check Check Number TOTAL CREDIT CARD American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name INQUIRIES: Contact the Association Executive, at the WSOA Office at 206-956-3652 or email admin@wsoa.org. Δ
