Download Sponsor Registration Form
[heading title_size=”title-size-large”]Sponsor Registration Form[/heading]

SPONSOR REGISTRATION FORM

Please download and fax this form to Faina Shtern at (617) 507-2439 or email to faina.shtern@admetechfoundation.org.

Please note that exhibits are limited in size to 6’ wide x 6’ deep. Set up of exhibits will take place on August 3.

NAME OF COMPANY:          _____________________________________________

REPRESENTATIVE:               _____________________________________________

Full Name:                  ________________________________________

Title:                           ________________________________________

E-mail:                        ________________________________________

Phone number:          ________________________________________

Address:                   ________________________________________

LEVEL OF SPONSORSHIP (See attached details):

Conference Partner $150,000 ____     Platinum $100,000 ___                  Gold $50,000 ___

Silver $25,000 ___                                Bronze Level: $10,000 ___            Exhibitor: $5,000___

METHOD OF PAYMENT

  1. Check ____

Please mail check payable to AdMeTech Foundation to:

AdMeTech Foundation, One Boston Place, Suite 2600, Boston, MA 02108

  1. Credit Card ____

Name on credit card: ________________               Amount to be charged: $__________


Credit Card Number: ______________________________                       Exp. Date: __________

          Approval of use via this signature: ___________________________________

          III. Wire Transfer or ACH____

                        Formal Name: Corporation for Advancement of Medical Technologies (DBA AdMeTech Foundation)

                       

                        Routing Number (Bank of America:

 

                                    For Wire___ 026009593

                                    For ACH___ 052001633)

                        Bank account____ 003916329827