Sports Medicine Course - Credit Card Payment Form

24th Annual AAOS/AOSSM/AANA Sports Medicine Course

Credit Card Payment Form

Company Name:*

Contact Name*

First NameLast Name

E-mail*

Phone Number:*

Payment Details

Exhibit Room Location*

6' x 6' booth - Food & Beverage Room 1$3,600.00

Quantity

6' x 6' booth - Kokopelli Ballroom Foyer$4,600.00

Quantity

Total $0.00

To pay by credit card, click the "Submit" button below. You will be taken to a PayPal website, where you can complete your order and enter credit card details. A receipt would be automatically sent to your e-mail address upon payment completion.

I am an authorized representative of the company named above with full power and authority to sign and deliver this application. The company listed above agrees to comply with all of the AAOS policies, rules, and regulations contatined in the Sports Medicine Course Prosepectus, AAOS CME Program Exhibit Rules and any regulations adopted after publication of each, which we accept as part of this agreement.

Electronic Signature*

Title*

Date: