If you would like to request display space for your company, please print and fill out the form below and mail to:
    American Society of Dermatology
    411 Hamilton Blvd., #1006
    Attn: Monica L. Craig
    Peoria, IL 61602

    If you have any questions please feel free to contact us at 309/676-4074 or for faster response send email to ASD. If we hear from you at an early date, appropriate recognition will be given in our registration material.

    For your records, our Federal Tax I.D. number is 73-1401658.
    American Society of Dermatology
    8th Annual Meeting
    Newport, Rhode Island
    October 1-3, 1999
    Hotel Viking

    Exhibitors Display Request Sheet

  • ____ YES, our company wishes to make an educational support contribution to the American Society of Dermatology's 8th Annual Meeting in the amount of $________________ but we do not wish to display. Enclosed is our check for same.

  • ____ YES, our company would like to make an educational support contribution and would also like to display. Enclosed is our check in the amount of $_______________. (A confirmation regarding your display space will be made upon receipt.)

    Please list a Contact name, Company name,
    Address, Telephone and Fax Information Below:

    Contact Name

    Company Name

    Street Address

    City, State, Zip

    Telephone Number/Fax Number