Vendor Registeration For the Conference | West Virginia Sleep Society

Your Name: (required) *

Business or Vendor Name: (required) *

Your Email: (required) *

Vendor Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Vendor Options:

Vendor Fee

Price: $ 500.00

Vendor Fee Includes:

Advertisement space on our website
Advertisement time in between the presentations
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Plus one complementary meeting registration with CEUs

Name of person receiving registration

First

Last

Phone

Email

SPONSORSHIP (Check item you wish to sponsor)

Checkbox Items

Educational Grant Bronze Donor - $ 500.00
Educational Grant Silver Donor - $ 1,500.00
Educational Grant Gold Donor - $ 2,500.00

Total

$ 0.00

Select a payment method:

Name

Thank you for registration for the upcoming conference. Once you fill out this registration form, you will be redirected to the payments page where you can review your payment options.