EXHIBITOR AND/OR SPONSORSHIP REGISTRATION FORM
The 45th Annual Indiana ACEP Post Graduate Course in Emergency Medicine is scheduled for April 26 & 27, 2017 at the Marriott Indianapolis North Hotel, 3645 River Crossing Parkway, Indianapolis, IN 46240.
We expect an attendance of over 90 Emergency Physicians, nurses, PA's & paramedics at this event.
You are invited to exhibit your products and/or services at this conference on THE AFTERNOON OF Wednesday (ONLY) April 26, 2017. You'll be able to set up while the registrants are at lunch, and stay until the end of the first break or the end of the day. The exhibit area will be in the Prefunction Area in front of the lecture room, on the first floor of the Marriott.
There will be a 45 minute afternoon break to allow you to mingle with the attendees.
The Marriott Indianapolis North Hotel is holding rooms for us at a rate of $149.00 per night. If you plan to stay at the Marriott, call them at 317-705-0000 and tell them you are with the Indiana Chapter of the American College of Emergency Physicians . Deadline for Hotel Reservations is April 5, 2017.
Please respond as early as possible. The exhibit area will hold 15 exhibitors which we will be assigning on a first come, first served basis.
DEADLINE FOR REGISTRATION WILL BE APRIL 5, 2017
There are additional sponsorship opportunities available for getting increased exposure at the conference. Unfortunately, CME guidelines do not allow us to provide complimentary exhibit tables with sponsorships. For any sponsorship of $500.00 to $1499.99, your name
Indiana ACEP Officers and Board of Directors 2016/2017
Lindsay Weaver MD, FACEP Board Members: Ex Officio Members:
President Bart Brown MD FACEP John Agee DO FACEP
Gina Huhnke MD, FACEP Chris Cannon MD FACEP Michael D Bishop MD FACEP
Vice President Emily Fitz MD Sara Brown MD FACEP
Chris Ross MD, FACEP Dustin Holland MD Chris Burke MD FACEP
Secretary-Treasurer Tyler Johnson DO FACEP Timothy Burrell MD FACEP
James Shoemaker MD, FACEP Andrew McCanna MD FACEP JT Finnell MD FACEP
Immediate Past President John Rice MD FACEP Chris Hartman MD FACEP
Courtney Soley MD Cherri Hobgood MD FACEP
E Nicholas Kestner III Lauren Stanley MD FACEP John McGoff MD FACEP
Executive Director Jonathan Steinhofer MD FACEP Michael Olinger MD FACE
Matt Sutter MD FACEP Chris Weaver MD FACEP
will appear in all of our printed material as a "Blue Level" sponsor. For any grant of $1500.00 or over - your name will appear in all of our printed material as a "Gold Level" sponsor. Both Blue and Gold Level sponsors will be acknowledged to our entire membership in our newsletter, the EMPulse.
Again, we expect over 90 registrants for the two-day conference.
If you need any additional information, please e-mail Sue Barnhart at: or call 317-846-2977.
Sincerely,
Sue Barnhart
Executive Assistant – INACEP
Please choose one of the three Registration forms enclosed: (ie; Exhibitor only, Sponsor only or Both) and return, along with check to Indiana ACEP.
Or, go to our website and register there to pay by credit card. www.inacep.org
Thank You!
Indiana ACEP Officers and Board of Directors 2016/2017
Lindsay Weaver MD, FACEP Board Members: Ex Officio Members:
President Bart Brown MD FACEP John Agee DO FACEP
Gina Huhnke MD, FACEP Chris Cannon MD FACEP Michael D Bishop MD FACEP
Vice President Emily Fitz MD Sara Brown MD FACEP
Chris Ross MD, FACEP Dustin Holland MD Chris Burke MD FACEP
Secretary-Treasurer Tyler Johnson DO FACEP Timothy Burrell MD FACEP
James Shoemaker MD, FACEP Andrew McCanna MD FACEP JT Finnell MD FACEP
Immediate Past President John Rice MD FACEP Chris Hartman MD FACEP
Courtney Soley MD Cherri Hobgood MD FACEP
E Nicholas Kestner III Lauren Stanley MD FACEP John McGoff MD FACEP
Executive Director Jonathan Steinhofer MD FACEP Michael Olinger MD FACE
Matt Sutter MD FACEP Chris Weaver MD FACEP
EXHIBITOR ONLY REGISTRATION FORM - Deadline April 5, 2017
45th Annual Indiana ACEP Post Graduate Course in Emergency Medicine
Marriott Indianapolis North Hotel, 3645 River Crossing Parkway, Indianapolis, IN 46240
EXHIBIT HOURS ARE THE AFTERNOON OF WEDNESDAY APRIL 26, 2017 ONLY
Company Name: ______
please type it exactly how you want it to appear in our advertising
Contact Name:______
this is the person that will receive all further information regarding set-up times, etc.
Contact Address:______
Contact City, State, Zip:______
Contact Phone:______
Contact E-Mail:______
Company Type:
q billing
q insurance
q pharmaceutical
q medical devices
q recruiting
q other - please explain
Attendee 1:______
Attendee 2:______
Booth Cost: (Booth is a 6 foot x 2 foot skirted table & 2 chairs) $500.00 q
Do you need electricity? Yes q
No q Cost of Electricity $50.00 q
TOTAL COST: ______
Please send registration & check to:
Indiana ACEP
630 No. Rangeline Rd. Suite D.
Carmel, IN 46032
If you would like to pay by credit card, please register via our website:
www.inacep.org
SPONSORSHIP ONLY REGISTRATION FORM - Deadline April 5, 2017
45th Annual Indiana ACEP Post Graduate Course in Emergency Medicine
Marriott Indianapolis North Hotel, 3645 River Crossing Parkway, Indianapolis, IN 46240
Company Name: ______
please type it exactly how you want it to appear in our advertising
Contact Name:______
this is the person that will receive all further information regarding paperwork that might be necessary to complete CME commercial support forms, etc.
Contact Address:______
Contact City, State, Zip:______
Contact Phone:______
Contact E-Mail:______
Company Type:
q billing
q insurance
q pharmaceutical
q medical devices
q recruiting
q other - please explain
I would like to sponsor the following event (s):
Day 1 - Wednesday April 26 Continental Breakfast $1500.00 q
Day 1 - Wednesday April 26 Morning Break $500.00 q
Day 1 - Wednesday April 26 Luncheon $2000.00 q
Day 1 - Wednesday April 26 Afternoon Break $500.00 q
Day 2 - Thursday April 27 Continental Breakfast $1500.00 q
Day 2 - Thursday April 27 Morning Break $500.00 q
Support of Speakers & Attendance of Residents (we can use several) $500.00 q
Printing our Handbook & Flashdrive (your logo appears on flashdrive and in handbook) $2000.00 q
TOTAL: ______
Please send registration & check to:
Indiana ACEP
630 No. Rangeline Rd. Suite D.
Carmel, IN 46032
If you would like to pay by credit card, please register via our website:
www.inacep.org
SPONSORSHIP & EXHIBITOR REGISTRATION FORM - Deadline April 5, 2017
45th Annual Indiana ACEP Post Graduate Course in Emergency Medicine
Marriott Indianapolis North Hotel, 3645 River Crossing Parkway, Indianapolis, IN 46240
EXHIBIT HOURS ARE THE AFTERNOON OF WEDNESDAY APRIL 26, 2017 ONLY
Company Name: ______
please type it exactly how you want it to appear in our advertising
Contact Name:______
this is the person that will receive all further information regarding set-up times, and etc.
Contact Address:______
Contact City, State, Zip:______
Contact Phone:______
Contact E-Mail:______
Company Type:
q billing
q insurance
q pharmaceutical
q medical devices
q recruiting
q other - please explain
Attendee 1:______
Attendee 2:______
Booth Cost: (Booth is a 6 foot x 2 foot skirted table & 2 chairs) $500.00 q
Do you need electricity? Yes q
No q
Cost of Electricity $50.00 q
I would like to sponsor the following event (s):
Day 1 - Wednesday April 26 Continental Breakfast $1500.00 q
Day 1 - Wednesday April 26 Morning Break $500.00 q
Day 1 - Wednesday April 26 Luncheon $2000.00 q
Day 1 - Wednesday April 26 Afternoon Break $500.00 q
Day 2 - Thursday April 27 Continental Breakfast $1500.00 q
Day 2 - Thursday April 27 Morning Break $500.00 q
Support of Speakers & Attendance of Residents (we can use several) $500.00 q
Printing our Handbook & Flashdrive (your logo appears on flashdrive and in handbook) $2000.00 q
TOTAL: ______
Please send registration & check to:
Indiana ACEP
630 No. Rangeline Rd. Suite D.
Carmel, IN 46032
If you would like to pay by credit card, please register via our website:
www.inacep.org