9 E D U C A T I N G A D V O C A T I N G N E T W O R K I N G I A C P C O M P O U N D E R S O N C A P I T O L H I L L E x h i b i t o r C o m m i t m e n t F o r m Company* __________________________________________________________________________________________________________ Contact Name ________________________________________________________________________________________________________ Address ____________________________________________________________________________________________________________ City ____________________________________State__________________________________ Zip ________________________________ Phone __________________________________ E-mail ________________________________ Web Site* ____________________________ __________________________________________________________________________________________________________________ Exhibit Coordinator (Exhibit kit will be emailed to this person) E-mail Phone *Exhibitor listing in meeting material will contain this information. Exhibitor Level Preference Sponsorship ____ Exhibitor and Sunday Continental Breakfast & Lunch Sponsor –$8,000 ($7,250 for Corporate Partners) ____ Exhibitor and Monday Continental Breakfast & Lunch Sponsor – $8,000 ($7,250 for Corporate Partners) ____ Premium Exhibitor – $5,000 ($4,250 for Corporate Partners) (4 available) ____ Exhibitor – $4,500 ($3,750 for Corporate Partners) Payment Calculation Exhibitor Level Total $ ________________ Additional Sponsorship Total $ ________________ Total Due IACP $ ________________ ____ Yes, my company will sponsor the following: LOGO ITEMS q Meeting T-shirt – $10,000 – SOLD q Meeting Tote Bag – $5,000 – SOLD q Meeting Syllabus – $5,000 – SOLD q Meeting Brochure – $4,000 – SOLD q Hotel Room Keys – $2,500 – SOLD q Name Badge Holder – $2,000 – SOLD q Conference Pen – $1,000 – SOLD CONFERENCE EVENT SPONSORSHIP q Videographer – $7,500 q Welcome Reception Honoring IACP Fellows – $6,000 – SOLD q State Breakfast/Hill Day – $5,000 q IACP AdvanCE Education Sessions - $4,000 (4 available) q Education Sessions – $3,000 (13 available) q Soapbox Consulting, LLC – $3,000 q Capitol Hill Debriefing & Closing Celebration – $2,500 q IACP Board & Foundation Board of Directors Meeting – $1,200 Acceptance of this application by IACP constitutes a contract. The total exhibitor/sponsor fee must be enclosed with this application. Payment We abide by the exhibition rules which are stated on Page 8, and which are a part of this contract ______________ (initial). q Check (Please make payable to IACP) q Send us an invoice q Credit Card (circle one): Discover VISA MasterCard AMEX Credit Card Number_______________________________________ Exp. Date _____________________ V-code __________________________ Card Holder’s Name _________________________________________________________________________________ Billing Address of Card ______________________________________________________________ (if different from above) Authorized Signature ________________________________________________________________________________ Person filling out this form (if different from above) ____________________________________________________________ IACP 4638 Riverstone Blvd. Missouri City, TX 77459 281-933-8400 FAX 281-495-0602 ©2013 International Academy of Compounding Pharmacists (IACP). All rights reserved.
IACP Compounders on Capitol Hill
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