Name of Representative(s) staffing the exhibitor platform:
Name of Attendee(s) with complimentary registration per Exhibitor Support Level:
Products, supplies, equipment and/or services to be displayed:
As an authorized representative of the company listed above, I understand that:
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Reasonable security measures will be taken for hybrid exhibits, but UT Health San Antonio accepts no responsibility for any exhibit contents, instruments, or equipment.
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Exhibitors may not assign, sublet or apportion a virtual space allotted, or exhibit any goods other than those manufactured or handled by the exhibitor in the regular course of their business.
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Exhibit payment does not support education and is only for the use of the exhibit space.
By typing my name above, i am electronically signing this form.
If signature is from other than Representative listed above, please provide information below:
Check
Make checks payable to: UTHSCSA CME - 170884
7703 Floyd Curl Drive, Mail Code 7980, San Antonio, TX78229-3900 Federal Tax ID# 74-1586031
Credit Card
We will contact you for credit card information.
