Exhibitor Application FormEchocardiography and Structural Heart Symposium, 39th AnnualOctober 27-28, 2022 | Thursday-FridayHilton Miami Airport Blue Lagoon, Miami, FloridaCompany/Contact Information Company Name * Please list your company name as it should appear in acknowledgements. Description of Company’s Products/Services * First Contact Name * Title Email * Phone * Second Contact Name Title Email Phone Payment DetailsExhibit Hall RateVirtual Exhibitors$15,000 (Platinum)$10,000 (Gold)$5,000 (Silver)$2,500 (Bronze) Select your support/exhibit type: * - Select -$15,000 (Platinum)$10,000 (Gold)$5,000 (Silver)$2,500 (Bronze) Important: Next StepsYour payment is for a Silver or Bronze exhibit.Check PaymentsTo make a check payment, please contact Julie Zimmett and submit a check payable and mailed to the following address:Baptist Health South Florida – Baptist HospitalCME Department (Tax ID # 65-0267668)Attn: Julie Zimmett8900 North Kendall Drive, Miami, FL 33176Credit Card PaymentsYou will be prompted to complete your credit card payment on the next page. If you cannot complete your credit card payment today, please contact Julie Zimmett after submitting the form. 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. Important: Next StepsYour payment is for Platinum or Gold support/exhibit.Check PaymentsTo make a check payment, please contact Megan Cottle and submit a check payable and mailed to the following address:Baptist Health South Florida Foundation (Tax ID Number 59-1923401) Attn: Megan Cottle, 2022 Structural Heart and Echo Imaging Symposium6855 Red Road, Coral Gables, FL 33143Credit Card PaymentsTo make a credit card payment, please contact Megan Cottle. 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.Subletting of exhibit space is not permitted.Baptist Health will not refund any fees paid under this agreement if the company cancels or does not use the exhibit space.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 reason; and (c) ban any exhibitor whose exhibit, materials or conduct is objectionable for any reason.Violation of any regulations on the part of the exhibitor, its employees or agents shall void the right to be included in the exhibit hall, and such exhibitor will forfeit to Baptist Health CME all monies they may have paid.Exhibitor shall release and hold harmless and indemnify Baptist Health from any and all claims, obligations, liabilities, causes of action, lawsuits, damages and assessments, including legal fees, that result from an allegation of negligence on the part of the exhibitor or Baptist Health or third parties in the use of the exhibit space or activities in connection with the use of the exhibit space.Note: The format of all events is subject to change. All events will take place in a safe and physically distant format that follows established recommendations by the CDC and Baptist Health South Florida policies.Special Accessibility NeedsIn accordance with the Americans with Disabilities Act, Baptist Health CME will make all reasonable efforts to accommodate persons with disabilities at this symposium. Please contact Julie Zimmett if you require special accomodations. AgreementI have read and I agree to the Terms and Conditions for Baptist Health CME Exhibit Hall Participation for the 2022 Structural Heart and Echo Imaging Symposium. Signature of Authorized Company Representative * Enter your full name. Leave this field blank