Application and Contract for Exhibit Space

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					                   AAOMS Dental Implant Conference                                                                                     Side A
                   December 3 - 6, 2009 Chicago, Illinois                                                                              Important:
                                                                                                                                       Please type or print this application
                                                                                                                                       Exhibitor must complete Sides A and

Application and Contract for Exhibit Space                                                                                             B, include payment info and sign
                                                                                                                                       before contract can be processed.
1. Return fully completed application, Side A and                     3. If space is cancelled before May 29, 2009, a full            and be subject to, the terms and conditions con-
B, with full payment by March 31, 2009, for priority                  refund of all monies will be made. If space is can-             tained in the Exhibitor Prospectus, including but
points to apply. Requests made after March 31,                        celled after May 29, but before June 30, 2009, 50%              not limited to the Exhibition Regulations. AAOMS
2009, will be assigned on a first-come, first-served                  of the total will be returned. No refund will be given          reserves the right to refuse or deny exhibit space
basis. Only a signed application/contract with full                   for space cancelled after June 30, 2009.                        at the AAOMS 2009 Dental Implant Conference to
payment will be accepted for booth assignment.                                                                                        prospective exhibitors.
                                                                      4. The acceptance of this application shall be at the
2. Facsimile copies are accepted to guarantee                         sole discretion of AAOMS, and upon acceptance,                  5. NEW. Space selection April 13-17, 2009. See
booth space with MasterCard, Visa, Discover or                        becomes a contract. By completing and signing this              page 6 of Prospectus.
American Express* card payment.                                       application, the undersigned agrees to comply with,             A signature is required to complete the contract.
                                                                      and be subject to, the terms and conditions con-                * There will be a 1.5% convenience fee added
                                                                      tained in the Exhibitor Prospectus, including but               for American Express card users.

__ Check here if you are a new exhibiting                                     C) Virtual Exhibit Hall (VHX) Product Category
     company.                                                                 Required for placement on the AAOMS website.

A) Company Information
                                                                              D) Booth Fee Calculator                                                   DISCLAIMER:
Please type or print clearly. (Note: Name and address of
                                                                              8’x10’ booth w/Virtual Exhibit Hall fee      $ 2,175.00                   With the exception of specific
company will be published EXACTLY as indicated below.                         (includes one (1) badge, food & beverage for one)
Please do not abbreviate.)                                                                                                                              products or services expressly

Company__________________________________________                             __ Additional booth(s), with badge, food &                                endorsed by the American
                                                                              beverage for one, at $2,075 each       =         $______________          Association of Oral and Maxillofa-
Street Address _____________________________________                          1 Corner     @ $175                     =        $______________          cial Surgeons (AAOMS), AAOMS

P.O. Box___________________________________________                           2 Corners @ $350                        =        $______________          does not endorse exhibit hall prod-
                                                                                                                                                        ucts or services, and the presence
City/State _________________________________________                          4 Corners @ $700                        =        $______________
                                                                                                                                                        of any exhibition at an AAOMS
                                                                              __ Additional badge(s), w/food & beverage,                                meeting or function does not imply
Zip Code__________________Country__________________                           at $100 ea. (max. of 4 add’l per booth) =        $______________
                                                                              (See rate chart on page 5)                                                an endorsement. By attending the
Telephone _________________________________________                                                                                                     AAOMS Dental Implant Confer-
                                                                              Total                                            $______________
Fax_______________________________________________                                                                                                      ence, registrants acknowledge and
                                                                              __Corner Optional     __Corner Mandatory       __Corner Preferred
                                                                                                                                                        accept that AAOMS has assumed
Web site Address ___________________________________                          E) Booth Preference                                                       no duty to review, investigate,
                                                                              NOTE: The exhibit configuration must comply with standard IAEE
                                                                              exhibition regulations. Certain booth sizes may require additional        or otherwise approve, and has
Information listed below is for AAOMS information only
and will not be published. Send all exhibition information                    lighting. (If your choices are not available, space may be assigned       not reviewed, investigated, or
to (specify contact name):                                                    by the AAOMS Exhibition Manager).                                         otherwise approved, the quality,
                                                                              _____1st Choice         _____3rd Choice           _____5th Choice         type, message, nature, or value of
Contact Person Name _______________________________                           _____2nd Choice         _____4th Choice           _____6th Choice         any product or service marketed
Title ______________________________________________                          Please note the companies that you do not wish to be located im-          by exhibitors. As such, attendees
                                                                              mediately adjacent to or immediately opposite in the exhibit hall:        should conduct their own indepen-
Contact Person Phone___________________Ext. _________                         ______________________________________________________                    dent research of such products
Contact Person Cell:_________________________________                         Please copy the floor plan and circle booth possibilities and             or services. AAOMS disclaims any
                                                                              submit with Side A and Side B of the application. You will be             liability for any damages to person
Contact Fax________________________________________                           contacted for your booth selection appointment time in April.             or property arising out of any
E-mail Address _____________________________________                          E) Payment. Full payment is due with this signed                          such product or service, and the
(Please list your e-mail address. Exhibitor bulletins and
                                                                              application/contract. Please check one:                                   attendee expressly waives any and
important updates may be sent via e-mail.)
                                                                              Check # __________ (payable in US currency, drawn on a US                 all claims related to or arising from
                                                                              account, to the American Association of Oral and Maxillofacial
General E-Mail______________________________________                                                                                                    any such product or service.
Product and Sales Inquiries for VXH (Virtual Exhibit Hall).                   Surgeons)
Example:                                                        __Visa     __ MasterCard   __Discover       __American Express*
                                                                                                                     3 Digit Code (  )
                                                                              Credit Card Number:_____________________________________                  Note:
                                                                                                                                                        Signed Application/Contract and
B) Product Listing                                                            Expiration Date:_________________________________________
                                                                                                                                                        payment must be received prior
A description of products and services must be provided                       Name of Card Holder:____________________________________                  to booth assignment being made.
for exhibit consideration by AAOMS. Please e-mail summary                     Cardholder Signature:____________________________________
as it should appear in the final program. Summary should
be 35 words or less (350 characters), otherwise subject to                    APV ______________________
AAOMS editing. E-mail the summary to: by July 31, 2009 or fax to                                  A signature is required to complete the application/contract.
                                                                              Contact Signature_______________________________________

FOR AAOMS USE ONLY                                                           Accepted by the American Association of Oral and Maxillofacial Surgeons.

Date                         Booth Size                       $ Amount Received              $ Balance              Check/Credit Card                   Booth(s) Assigned                Rank
Product information is required and it is understood that it may be printed in the final meeting program.
Please list each product or service to be exhibited and check any columns that apply and/or describe its
                                                                                                                      Side B
present status:                                                                                                       Important:
                                                                                                                      Please type or print this application
Product                                                  Product has        Product           Previously              Exhibitor must complete Sides A and
                                                         FDA Premarket      is FDA            Exhibited at an         B, include payment info and sign
                                                         Approval           Approved          AAOMS Meeting           before contract can be processed.
                                                         o                  o                       o
                                                         o                  o                       o                            EXHIBITION
                                                         o                  o                       o                            REGULATIONS:
                                                         o                  o                       o                            The Exhibition Regulations
                                                                                                                                 governing exhibitors as printed
If any of these products are currently in litigation with a government agency or are the subject of an unfavorable or
                                                                                                                                 in this publication are part of the
cautionary report by an agency of the American Dental Association, please note here and explain:
______________________________________________________________________________________________________                           contract. All exhibitors and their
                                                                                                                                 representatives must abide by these
                                                                                                                                 regulations. Acceptance of exhibiting
Will your company be exhibiting anything categorized as FDA Class III? Yes  No                                                   firms by AAOMS and assignment
If yes, please explain:                                                                                                          of booth space will be coordinated
                                                                                                                                 by the AAOMS Exhibition Manager.
______________________________________________________________________________________________________                           Verification of same will be sent to
                                                                                                                                 the exhibitor. Drug products must be
Product Category Index — Check each item you will have on display at the 2009 Dental Implant Conference
                                                                                                                                 classified as accepted or provision-
If you have additional products or services available that are not listed here, please check “Other” and describe as
generally as possible for publication.                                                                                           ally accepted by the ADA’s Council on
                                                                                                                                 Dental Therapeutics, or have been
❍ Anesthesia/Emergency/          ❍ Dental Implant Systems         ❍ Lasers/Electrosurgery         ❍ Practice Management          issued new drug
  Oxygen Equipment                                                  Products
                                 ❍ Education/Training:                                            ❍ Precious Metals              applications by the US Food and Drug
❍ Art                            ---- Staff ---- Patient          ❍ Market Research/
                                                                                                  ❍ Recruiting                   Administration. Claims pertaining to
❍ Association/Organization       ❍ Facial Implant Products                                                                       dental devices or products must be
                                                                                                  ❍ Surgical Equipment
                                                                  ❍ Medical/Dental Publishing
❍ Blood/Tissue Bank              ❍ Financial Services                                                                            acceptable under the ADA’s Council
                                                                  ❍ Monitoring Equipment          ❍ Surgical Supplies/Sutures
❍ Cameras/Photography            ❍ Grafting Materials               Supplies                                                     on Dental Materials, Instruments and
                                                                                                  ❍ TMJ Devices
  Equipment                      ❍ Hand/Surgical Instruments                                                                     Equipment. AAOMS will not be held
                                                                  ❍ Nutrition                     ❍ Telescopes/Light Sources
❍ Cleaning/Sterilizing Equip-                                                                                                    liable for scientific context of descrip-
                                 ❍ Imaging and Diagnostics        ❍ Office Communication
  ment                                                                                            ❍ Web Design
                                 ❍ Infection Control                Systems                                                      tions provided by exhibiting firms to
❍ Computer Hardware/Software                                                                      ❍ X-Ray Equipment/Film
                                 ❍ Intraoral Cameras              ❍ Office Furniture/Design                                      be printed in the 2009 Dental Implant
❍ Cosmetics                                                                                       ❍ Other________________
                                 ❍ Laboratory Services/           ❍ Office Supplies                                              Conference Final Program.
❍ Dental Implant Equipment         Supplies                                                       ❍ Other________________
                                                                  ❍ Pharmaceuticals/Drugs

For more information on corporate support and/or marketing options, please complete and return this form.

Corporate Support Opportunities                                   Marketing                                                      FCC COMPLIANCE
                                                                                                                                 In order for AAOMS to be in compli-
❍ AAOMS Web Site                 ❍ Beverage Breaks                 ❍ Membership Mailing Labels ($700.00)                         ance with the pending FCC regula-
❍ Audiovisual Equipment          ❍ Lunch for Attendees in          ❍ Pre-registration Mailing Labels ($275.00)                   tions, we would like you to consider
                                   Exhibit Hall                                                                                  signing this form so AAOMS may keep
❍ Badge Lanyards/                                                  ❍ Post-conference Mailing Labels ($325.00)
  Pocket Badge Holders                                                                                                           you informed of the latest changes,
                                 ❍ Welcome Reception for           ❍ Function Space Request                                      products and services being offered.
❍ Educational Sessions             Attendees in Exhibit Hall                                                                     Signing this form will also allow
                                                                   ❍ Advance and/or Final Program Advertisement
❍ General Fund                   ❍ Internet Center                                                                               AAOMS and its official contracted
                                                                   ❍ Hotel Channel Airtime                                       service suppliers to continue faxing
❍ Hotel Key Cards                ❍ Other (please list)                                                                           you important information about the
                                                                   ❍ Hotel Door Drop
❍ Pens and Notebooks             ________________________                                                                        Association and conference services.
                                                                                                                                 AAOMS must have your signature on
                                                                                                                                 file. Note that AAOMS never sells or
(Print or type)                                                                                                                  shares its exhibitors’ telephone, fax or
                                                                                                                                 e-mail contact information to outside
Name: ________________________________________________________________________________________________                           parties. Please acknowledge your
                                                                                                                                 consent by signing below, and faxing
                                                                                                                                 this form back to AAOMS at secure
Company:______________________________________________________________________________________________                           fax number 847/233-9331.
City:____________________________________________State:_______________Zip:_ ______________________________                       Your preferred fax number:
Phone:__________________________________________Fax:___________________________________________________                          _______________________
E-mail Address:_________________________________________________________________________________________                         Signature: _________________

Virtual Exhibit Hall e-mail info address:______________________________________________________________________                  Date: _____________________

E-Mail, fax or mail form to:
Debbie Skrzypek, Staff Associate, Exhibition
AAOMS, 9700 West Bryn Mawr Avenue
Rosemont, IL 60018–5701
847/233-4331 | SECURE FAX: 847/233-9331
e-mail applications to: