Exhibitor Application FormBaptist Health Spine SymposiumCompany/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 RateVirtual Exhibitors$25,000 (Platinum)$15,000 (Gold)$5,000 (Silver)$2,500 (Bronze) Select your exhibit type: * - Select -$25,000 (Platinum)$15,000 (Gold)$5,000 (Silver)$2,500 (Bronze) Important: Next StepsYour payment is for a Silver or Bronze virtual 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. 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 a Platinum or Gold virtual exhibit.Check PaymentsTo make a check payment, please submit a check payable and mailed to the following address:Baptist Health South Florida Foundation (Tax ID Number 59-1923401) Attn: Baptist Health Virtual Spine 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 companies’ 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 reason.Violation 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 I agree to the Terms and Conditions for Baptist Health CME Exhibit Hall Participation for the 2022 Baptist Health Virtual Spine Symposium. Signature of Authorized Company Representative * Enter your full name. Leave this field blank
