Test form stripe integration registration Please enable JavaScript in your browser to complete this form.Company Name *Email address for registration and payment receipts (may be different than 1st attendee) *Address *Address Line 1Address Line 2CityFloridaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePlease select your exhibit booth &/or sponsor options. *Exhibit Booth Registration $850Double Exhibit Booth $1,625Add’l Drink Ticket Package $75Platinum Sponsor $5,000Gold Sponsor $2,500Silver Sponsor $1,500Program Ad $1,100Awards Banquet Sponsor $1,000Hospitality Sponsor $1,000T-shirt Sponsor $600Break Sponsor $500Student Scholarship Fundraiser Event Sponsor $500SOLD – Lanyard SponsorTechnical Session Sponsor $250Tuesday Workshop Sponsor $200How did you hear of the FLMS Symposium?FLMS emailColleagueFLMS WorkshopSocial MediaOther1st Attendee Name (2 people are allowed per exhibit booth registration, complete 2nd below if needed) *FirstLast1st Attendee Designations, i.e. Ph.D., P.E., M.S., etc.1st Attendee Email *1st Attendee Cell Phone *1st Attendee: I require a special dietary meal. Please state which type.1st Attendee: I require ADA assistance – please explain type.1st Attendee: How would you like your FIRST name to be displayed on your name tag?1st Attendee: T-shirt size *SmallMediumLargeXL2X3X2nd Attendee NameFirstLast2nd Attendee Designations, i.e. Ph.D., P.E., M.S., etc.2nd Attendee Email 2nd Attendee Cell Phone *2nd Attendee: I require a special dietary meal. Please state which type.2nd Attendee: I require ADA assistance – please explain type.2nd Attendee: How would you like your FIRST name to be displayed on your name tag? 2nd Attendee: T-shirt sizeSmallMediumLargeXL2X3XExhibit Booth Cancellation Policy: I understand cancellations must be received in writing before midnight on August 1 to receive a full refund. Cancellations between August 2 and August 11 will receive a refund, less a $75 processing fee. Fees will not be refunded for registrations cancelled after August 11 or for no-shows. Sponsorships are non-refundable. *I understandPhoto/Image Release: By registering for the FLMS Annual Symposium, I hereby grant FLMS permission to use any and all photographic imagery and video footage taken of me at this event and activities pertaining to this event, without payment or any other consideration. I understand that such materials may be published electronically or in print, or used in presentations or exhibitions. *I understandComment or MessageTotal Amount$ 0.00Payment method *Credit CardCheckStripe Credit Card *CardName on CardCommentSubmit Share this:FacebookXLike this:Like Loading...
