Corporate Response Form (PDF)

CORPORATE RESPONSE FORM Company Name: __________________________________________________________________ Representative: __________________________________________________________________ Phone #: _________________________ E-Mail: _______________________________________________ Authorized Representative Signature: _________________________________________________________ (must be signed to be accepted by ASCP) PRODUCT THEATERS £ FRIDAY, AUGUST 4TH Luncheon Product Theater - $1,000

£ SATURDAY AUGUST 5TH (Tentative) Off-Site Dinner Product Theater - $800

£ SATURDAY, AUGUST 5TH Breakfast Product Theater - $1,000

£ SUNDAY AUGUST 6TH Breakfast Product Theater - $800

£ SATURDAY, AUGUST 5TH Lunch Product Theater - $1,500 For all Product Theaters: ASCP will provide the following: banquet room, podium, podium microphone and wireless lavaliere. A LCD projector is also available on request. The product theater sponsor is responsible for the speaker expenses and the cost of the meal.

£ Exhibit / Display Table – $ 975.00

TAX ID#52-0942322

£ A Check Is Being forwarded to MD-ASCP

£ Send Me an Invoice

Credit Card Payments $________________ to £ MasterCard

£ VISA

£ AMEX

£ Discover

Card # ___________________________________ CSV Code# __________Exp. Date _________ Address Associated with Card: _____________________________________________________ Printed Name: ___________________________ Signature: ______________________________ Cancellation Policy: Display booths cancelled before Friday June 23, 2017 will be refunded 50% of fee paid. No refunds will be issued for booths cancelled after Friday June 23, 2017. § FAX THIS FORM WITH CREDIT CARD PAYMENT TO: 703/739-1321; § OR MAIL A CHECK TO: MID-ATLANTIC-ASCP, 1321 Duke St., Alexandria, VA 22314-3563

THANK YOU FOR YOUR SPONSORSHIP