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Commercial Exhibit Space Application and Agreement by cometjunkie50

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Commercial Exhibit Space
Application and Agreement
October 16-20, 2010 – San Diego, California
Exhibit Dates: October 17-19, 2010
See Prospectus for Exhibit Hours


Contact Information
Company Name (Exhibitor): __________________________________________________________________________________________________

Address: _________________________________________________________________________________________________________________

City: ____________________________________________ State: ___________________________ ZIP Code: _______________________________

Contact Name: ___________________________________ Phone: __________________________ Fax: ____________________________________

E-mail: __________________________________________________________ Web Site: ______________________________________________

Billing Information (if different from contact information)
Address: _________________________________________________________________________________________________________________

City: ____________________________________________ State: ___________________________ ZIP Code: _______________________________

Contact Name: ___________________________________ Phone: __________________________ E-mail: _________________________________

Booth Choices
ASA is hereby authorized to reserve space for our exhibit at the 2010 Annual Meeting of the American Society of Anesthesiologists. Our choices follow:
1. Booth # ___________ Size ______________ at $ ______________                            2. Booth # ___________ Size ______________ at $ _____________

3. Booth # ___________ Size ______________ at $ ______________                            4. Booth # ___________ Size ______________ at $ _____________

5. Booth # ___________ Size ______________ at $ ______________                            6. Booth # ___________ Size ______________ at $ _____________

We wish to avoid having our exhibit located directly adjacent to or opposite the following companies:

 _____________________________________________________                                __________________________________________________________

 _____________________________________________________                                __________________________________________________________

   Logo Stopper $500 – your company or product logo next to your exhibit listing in the ASA Exhibit Guide; dimensions 1¼” x ½” (send high resolution
EPS file to r.berg@asahq.org)

   New Product Flag $500 – new product flag next to your exhibit listing in the ASA Exhibit Guide; dimensions ½” x ½” (send high resolution EPS file to
r.berg@asahq.org)

Payment
A 50% deposit of total booth rental is required with the application. Applications received without the correct deposit will be returned. The application and correct deposit must
be received before space can be assigned. No exceptions. Please make checks payable to the American Society of Anesthesiologists. Checks must be drawn on a U.S. bank.
Credit card payments by VISA, MasterCard and American Express are accepted.

               VISA                    MasterCard                           American Express
Card number: _____________________________________________________________________ Exp. Date: ______________________________
Exhibitor agrees to abide by all terms and conditions in the 2010 prospectus and Exhibitor accepts relocation to another space of equivalent area should such a relocation
become necessary for causes beyond the control of, or if advisable, in the judgment of the American Society of Anesthesiologists. For good and valuable consideration,
receipt of which is hereby acknowledged, and as the date signed below by an authorized representative of the Exhibitor, this Agreement is effective between the above-
identified Exhibitor and the American Society of Anesthesiologists (ASA), a New York not-for-profit corporation, with its principal place of business at 520 N. Northwest
Highway, Park Ridge, Illinois, 60068. The parties consent to this Agreement, including the 2010 Annual Meeting Commercial Exhibit Prospectus, which is attached to this
agreement and incorporated by reference. This constitutes the entire Agreement between the parties, and representatives or statements, both oral and/or written, not included
herein are not binding on the parties.

Signature: ________________________________________________________________________ Date: __________________________________

  For ASA Office Use
  Priority Points __________________________________________ Booth Rental _____________________________________________

  Sponsorship Priority Points _______________________________                                Logo Stopper _________________________________________

  Date ________________________________________________                                      New Product Flag _____________________________________

  Booth Size ____________________________________________ Total Rental _______________________________________________

                                                                                      50% Deposit (due by 11-2-09) ________________________________

  Booth Assignment _____________________________________ 50% Balance (due by 3-1-10) _________________________________
                          Applications should be returned to: ASA, 520 N. Northwest Hwy., Park Ridge, IL 60068 or by e-mail to Rose Berg at r.berg@asahq.org
                                                                              or by fax to (847) 825-1692
Company and Product Information
List your company products or services below. Please note this is how your company and products/services information will appear on all conference
related materials. ASA reserves the right to edit as necessary for conference materials.

Company Name: __________________________________________________________________________________________________________

City: _________________________________________________ State: _____________________________________________________________

Phone Number: ________________________________________ Web Site: ___________________________________________________________

Description: (75 words or less)




Product Categories
Please indicate below the type of products/services your company will exhibit.

   Airway Management              Critical Care Monitoring                               Laryngoscopes                         Protective Wear
   Anesthesia Carts               Education                                              Needles/Syringes/Pumps                Publisher
   Anesthesia Instruments         Forced Air Warming                                     Nonprofit Organization                Pulse Oximeters
   Beds/Tables                    Gas Indicators                                         Pain Management                       Research Services
   Billing Services               Hypo/Hyperthermia Systems                              Patient Gowns                         Software
   Blood Management Systems       Imaging Systems                                        Patient Warming                       Staffing Services
   Blood Pressure Monitors        Infusion Pumps                                         Pharmaceuticals                       Suction Devices
   Blood/Fluid Warming Systems    Insurance                                              Point of Care Ultrasound              TEE
   Cannulas                       Intraoperative Ultrasound                              Practice Management                   Ventilation Equipment
   Other ______________________________________________




  Special Notes




                       Applications should be returned to: ASA, 520 N. Northwest Hwy., Park Ridge, IL 60068 or by e-mail to Rose Berg at r.berg@asahq.org
                                                                           or by fax to (847) 825-1692

								
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