Form

Exhibitor Request Form
Northwest Urological Society
56th Annual Meeting
December 4-5, 2009 Bellevue Hyatt Regency
Number of 8x10 Exhibit Booths @$2000 each (Includes registration for up to 3 company representatives)
Name of Point person for the Exhibit(s)*
Company
Address:
City:
State:
Zip code:
Phone:
Fax:
E-mail:*
Names of Representatives staffing exhibit booth: (email information is REQUIRED)
Rep. Name 01
Rep. 01 email
Rep. Name 02
Rep.02 email
Rep. Name 03
Rep. 03 email
NOTE: Additional representatives will need to pay an $85 Registration Fee to help cover the expense of meals provided.
Special Requests:
Number of Booths Needed:
Check off as many Exhibit Booths as Needed. (8x10 booths, includes registration for up to 3 company representatives.)
Exhibit Booth (8x10) $2,000.00 USD
Exhibit Booth (8x10) $2,000.00 USD
Exhibit Booth (8x10) $2,000.00 USD
Exhibit Booth (8x10) $2,000.00 USD
Exhibit Booth (8x10) $2,000.00 USD

Total: $0.00 USD
Pay by Check
1) Submit this online form and mail your Check To: NWUS, 914 164th St. SE, Suite B-12 #145, Mill Creek, WA 98012
Check Amount
Check Number
mailed on
- Month - Day Year
at
/ Hour Minutes
Should be Empty:

Exhibitor Request Form