Family Medicine Midwest 2014 Residency Fair Exhibit Application

IAFP Annual Meeting
2019 Supporter/Exhibitor
October 19, 2019 - Naperville, IL

The IAFP Annual Meeting offers the opportunity for our partners to network and exhibit in the hub of the meeting space. Exhibits at the Primary Care Resource Fair will be featured in the main area of the conference center. The IAFP Annual Meeting offers networking with Illinois’ family medicine physician leaders in a relaxed and welcoming setting.

Tax ID 36-2150319

Institution Primary Contact

First Name *

Last Name *

Organization name as it should appear on the web site, onsite program and signage *

Email Address *

Billing Address

Street Address *

Address Line 2

City *

State *

Postal Code / Zip Code *

Phone Number *

Institution's web site address

Choose your support level

*

Platinum Supporter/Exhibitor - $5,500 Gold Supporter/Exhibitor $2,500 Silver Level (No exhibit) $1000 Bronze Level (No exhibit) $500

Please provide a one-sentence summary of your organization

Names of your two onsite representatives (Platinum and Gold level only). You can use TBD if you are unsure at this time

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