Sponsor Registration

Organization/Company Name:
Natue of Organization/Company:
Organization/Company Director(s):
Contact Name:		Title:
Street Address:
City:		State:	Zip Code:
Phone:
Fax:
Email:
I want to be a:	Diamond Sponsor ($1200) Platinum Sponsor ($900) Gold Sponsor ($600) Silver Sponsor ($300) No Package ($0)
Optional Additions:	Residency Fair and Exhibition Hall Table ($575) Logo on Our T-shirts ($400) Lecture Sponsorship ($300) Full Page Ad ($250) Half Page Ad ($150)

By clicking on the "Submit Registration" button above, you agree to pay the registration fee
as determined by the pricing guidelines that can be found here.

You also agree you have read and agree to abide by all the requirements, restrictions, and obligations listed in our contract, which can be found here. PLEASE PRINT A COPY FOR YOUR RECORDS!

Full nonrefundable payment is due upon receipt of completed and approved contract with authorized signatures. Reservations will not be confirmed until full payment received. Payment is considered delinquent thirty days after final billing date. Monthly charge of 1.75% of outstanding fees detailed above will apply to delinquent accounts thirty-one days or more outstanding until all fees are paid. All costs of collection efforts will be the responsibility of the exhibitor including but not limited to collection agency fees and/or attorney fees incurred during collection process.

For your added convenience, you may pay online by viewing our payment page here. You also have the option of mailing us a check (addressed to AMSA Conference Regions 1,2,3) to:

AMSA Residency Fair c/o Student Affairs
Temple University School of Medicine
3500 North Broad Street Suite 325
Philadelphia, PA 19140

Click Below to Change Page

Sponsor Registration