Exhibitor Application FormPrimary Care Symposium OnlineCompany/Contact Information Company Name * Please list your company name as it should appear in acknowledgements. Description of Company’s Products/Services * First Contact Name * Email * Phone * Second Contact Name Email Phone Payment DetailsExhibit Hall RateTiered Support - Advertising opportunities and virtual exhibit video included.$10,000 (Gold)$5,000 (Silver)Exhibitors - Virtual exhibit PDF only.$1,000 (Standard) Select your exhibit type: * - Select -$10,000 (Gold)$5,000 (Silver)$1,000 (Standard) Is your company a Corporate Philanthropy Partner of Baptist Health Foundation? * - Select -YesNo Important: Next StepsYour payment is for a Silver or Standard 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: Julie Zimmett8900 N. Kendall Drive, Miami, FL 33176Credit Card PaymentsYou will be prompted to complete your credit card payment on the next page. Important: Next StepsYour payment is for a Gold exhibit.More Information - Corporate Philanthropy PartnerFor more information about becoming a Corporate Philanthropy Partner of Baptist Health Foundation, contact Megan Cottle:Email: MeganCo@BaptistHealth.netPhone: 305-807-7875Check PaymentsTo make a check payment, please submit a check payable and mailed to the following address:Baptist Health South Florida Foundation (Tax ID # 59-1923401)Attn: Primary Care Focus Symposium Online6855 Red Road, Coral Gables, FL 33143 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 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 virtual 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. AgreementI have read and I agree to the Terms and Conditions for Baptist Health CME Exhibit Hall Participation for the Primary Care Focus Symposium. Signature of Authorized Company Representative * Enter your full name. Leave this field blank