Exhibitor Application FormMiami Cancer Institute’s Oncology Rehab Symposium:Restoring Function and Maximizing Quality of LifeCompany/Contact Information Company Name * Please list your company name as it should appear in acknowledgements. First Contact Name * Email * Phone * Second Contact Name Email Phone Payment DetailsExhibit Hall RateVirtual Exhibitors$2,500 (Gold)$1,000 (Silver) Select your exhibit type: * - Select -$2,500 (Gold)$1,000 (Silver) Important: Next StepsYour payment is for a Gold or Silver 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: Audrey Gurskis8900 N. Kendall Drive, Miami, FL 33176Credit Card PaymentsYou will be prompted to complete your credit card payment on the next page. Baptist Health Foundation - Corporate Philanthropy Partners Is your company a Corporate Philanthropy Partner of Baptist Health Foundation? * - Select -YesNo - I would like more information. If you would like more information about becoming a Corporate Philanthropy Partner of Baptist Health Foundation, please contact Megan Cottle at MeganCo@BaptistHealth.net or 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 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 otherwise require 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 in the virtual event. AgreementI have read and understand the Baptist Health CME Symposium Exhibit and Exhibitor Terms and Conditions and agree to participate in the 2021 Virtual Oncology Rehab Symposium as an exhibitor as indicated in this contract. Signature of Authorized Company Representative * Enter your full name. Leave this field blank