INDUSTRY BADGE FORM 2015 OSUA MEETING: February 27-28, 2015 **Complete by February 6, 2015** Name of Company: ________________________________________________________________________ Standard exhibitors: 2 badges Gold Level Partners: 6 badges Platinum Level Partners: Unlimited badges EXHIBIT/SILVER: E-mail Address 1. _______________________________________ ___________________________________ 2. _______________________________________ ___________________________________ Gold/Platinum: 3. _______________________________________ ___________________________________ 4. _______________________________________ ___________________________________ 5. _______________________________________ ___________________________________ 6. _______________________________________ ___________________________________ Additional exhibitor badges are $175 each. Name : E-mail Address 1. _________________________________ ______________________________ 2. _________________________________ ______________________________ 3. _________________________________ ______________________________ 4. _________________________________ ______________________________ TOTAL FOR ADD’L EXHIBITOR REGISTRATIONS # Badges ______ X $175 = $ __________ PAYMENT: Please send any additional payment to:  Visa/MC/American Express Card Type/Number: _____________________________ Amount: ______________________________________ Exp. Date: _____________________________________ CVV # : _______________________________________ Signature:___________________________ Oklahoma State Urological Association 1100 E. Woodfield Rd Suite 350 Schaumburg, IL 60173 Fax (847) 517-7229 Questions: Contact Melissa Wright at the OSUA office 847-264-5915 or [email protected] Exhibit Hours Exhibit Set Up: Friday, February 27, 2015 4:30 pm – 6:30 pm Exhibit Hours: Friday, February 27, 2015 6:30 pm – 7:30 pm Saturday, February 28, 2015 7:00 am – 11:00 am (Welcome Reception in Exhibit Hall) Exhibit Teardown: Saturday, February 28, 2015 After 11:00 am Shipping Information 1. Do not send any materials earlier than one week prior to the meeting. 2. Bring your own return shipping labels if possible. 3. Please have all boxes clearly labeled with the following. Additionally it helps to number “1 of 3” “2 of 3” so that the hotel knows how many to look for. Shipping address: The Mayo Hotel Attn: Your Exhibiting Attendee’s Name 2014 Oklahoma State Urological Association Meeting 115 W. 5th Street Tulsa, OK 74103