Organization Name
Primary Contact First Name
Primary Contact Last Name
Job Title
Email
Address
Phone/Cell
Mailing Address
Please describe your organization and the products/services you wish to showcase
How does your organization support family physicians or patient care?
Names and roles of representatives attending the booth: (Maximum of two (2) representatives included per booth. Additional representatives may be accommodated for an additional fee)
Standard Size Booth: 8’ x 6’ Includes Table, chairs, basic power
Number of booths requested 1 booth2 booths (subject to availability)
$600 + GST per booth
Do you require any of the following? (Electrical Access, Additional chairs, Dietary Restrictions, Other)
