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- 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
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