Sponsor Application Vacation CE 2024 | Page 2

PDA ’ s Family Vacation Dental Conference August 15-17 , 2024 at the Hyatt Regency Chesapeake Bay Golf Resort , Spa & Marina

Sponsor Applicant / Contract :

Each exhibit is limited to individuals , business firms , manufacturers and dealers who have contracted and paid for space . Exhibit personnel must be bona fide employees of the sponsoring company or representatives who receive commission , brokerage or salary from the sponsor .

Instructions :

Please complete all sections of this contract and print as clearly as possible so we can translate the information accurately .

Please complete and return to PDA , Attn : Rebecca Von Nieda , PO Box 3341 , Harrisburg , PA 17105 or fax ( 717 ) 232-7169 or email rvn @ padental . org no later than August 1 , 2024 .

Your choice of sponsorships :

� Grand Sponsor - $ 2,000 � Exhibit Table August 15-17 - $ 750

� Reception on August 16 - $ 500 � Coffee Break - $ 250

( Please Print )

Company Name

Mailing Address Company Website Address Phone Number Name , Phone Number & Email of Person Completing Form

Authorized Signature ( individual who has authority to enter into contracts on behalf of the company )

Amount due : $ __________

Method of Payment

� Check made payable to PDA

� MasterCard � Visa � Discover � Amex Credit Card Number Expiration Date Billing Address

Please complete and return to PDA , Attn : Rebecca Von Nieda , PO Box 3341 , Harrisburg , PA 17105 or fax ( 717 ) 232-7169 or email rvn @ padental . org no later than Thursday , August 1 .

Refunds

All cancellations must be in writing and sent to rvn @ padental . org or fax to ( 717 ) 232-7169 . If the cancellation is received by August 5 , the company will receive a refund less an administrative fee of $ 50 . No refunds will be issued for cancellations received after August 5 .