Family Medicine Midwest 2014 Residency Fair Exhibit Application

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 - $5,500Gold Supporter/Exhibitor $2,500Silver Level (No exhibit) $1000Bronze Level (No exhibit) $500Other
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
Upload a JPG or PNG file of your logo here

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