Exhibitor Application FormMiami Cancer Institute Women’s Cancer SymposiumCompany/Contact Information Company Name * Please list your company name as it should appear in acknowledgements. Company Address * First Contact Name * Title * Email * Phone * Second Contact (Optional) Name Title Email Phone Payment DetailsVirtual Exhibitors$3,500 (Gold)$2,500 (Silver)$1,500 (Bronze) Select your exhibit type: * - Select -$3,500 (Gold)$2,500 (Silver)$1,500 (Bronze) Payment: Next StepsYour payment is for a Gold, Silver, or Bronze exhibit.Check PaymentsTo make a check payment, please submit a check payable and mailed to the following address:Baptist Health CME Department (Tax ID Number 65-0267668)Attn: Rossy Martinez8900 N. Kendall Drive, Miami, FL 33176Credit Card PaymentsClick here to complete your secure credit card payment form in a separate window. Baptist Health Foundation - Corporate Philanthropy Partners Is your company a Corporate Philanthropy Partner of Baptist Health Foundation? * - Select -YesNo More Information - Corporate Philanthropy PartnerFor more information about becoming a Corporate Philanthropy Partner of Baptist Health Foundation, contact Megan Cottle:Email: MeganCo@BaptistHealth.netPhone: 786-467-5534 Terms and ConditionsFor the purpose of this agreement, “Exhibitor” refers to the company(ies) represented at this event, as well as the company’s(ies’) representative(s) present at this event; and “Baptist Health” refers to Baptist Health South Florida, its affiliates, subsidiaries, contractors, departments and/or employees.Baptist Health will not refund any fees paid under this agreement if the company cancels 72 hours prior to the event.Baptist Health CME reserves the right to (a) reject any exhibit application; (b) reject, prohibit, restrict or otherwiserequire modification of any exhibit for any reasonViolation of any regulations on the part of the exhibitor, its employees or agents shall void the right to participate inthe virtual event. AgreementI have read and understand the Baptist Health CME Symposium Exhibit and Exhibitor Terms and Conditions and agree to participate in the Miami Cancer Institute Women’s Cancer Symposium as an exhibitor as indicated in this contract. Signature of Authorized Company Representative * Enter your full name. Leave this field blank
