Advances in Cosmetic & Medical Dermatology - Exhibitor Registration Form

APPLICATION TO EXHIBIT
* Denotes Required Fields

* Company Name:
* Company Address:
Company Address 2:
* City:
* State:
* Zip Code:
* Phone:
Fax:
* Email:
* Confirm Email:
* Contact Person:
* On-Site Contact Person:
* On-Site Contact Person Email:
* Company Name To Appear On Sign (one line):

Exhibiting Information

Booth fees are $2250.00 USD per 8" x 10" area if space is booked prior to June 30, 2008.
After July 1, 2008 - $2500.00 USD.
NOTE: No refund after October 30, 2008.

Last Name	First Name
1.		(Included)
2.		@ extra cost of $300.00
3.		@ extra cost of $300.00
Note: Exhibitors are invited to all meeting sessions and social functions.
Remarks/Comments:

Payment Information for Additional Registration

Cardholder Name:
Payment Type:
Card Number:
Card Expiration Date:
CID:
Payment Amount:	$
Make Checks Payable To:	Advances in Cosmetic & Medical Dermatology
Send To:	ACMD 41 East Lipoa St., Ste 21 Kihei, HI 96753

ACMD Administrative Office
41 E. Lipoa Street, Suite #21
Kihei, Maui, HI 96753
Email: information.services@acmd-derm-hawaii.com