2025 Exhibitors & Sponsors Registration | Maryland Chapter of ACEP

2025 Exhibitor & Sponsor Registration Form

Company Name(Required)

Type of Exhibitor(Required)

Other(Required)

Please describe what your company does. If your company sells anything, please let us know what they sell.

Point of Contact(Required)

First Last

Business Address(Required)

Please enter the address you would like any correspondence to be sent (if applicable).

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Main Business Website(Required)

Point of Contact Email(Required)

Enter Email Confirm Email

Point of Contact Cell Phone(Required)

What medicine(s) will you be speaking on?(Required)

What device will you be speaking on?(Required)

What items will you be demoing or selling?(Required)

Information Required for Advertising and Display Purposes

Specific Product Website if Applicable(Required)

Company Logo(Required)

Please upload a JPG, PNG or TIFF file of your company logo for advertising purposes.

Accepted file types: jpg, png, pdf, tiff, Max. file size: 50 MB.

What level of Exhibitor are you interested in?(Required)

Platinum Level

Silver Level

Breakfast Sponsor

Lunch Sponsor

Exhibit Level

Additional Representative(s)

This section is for additional company representatives, except for the Exhibitor Level, which allows only one representative.

Second Representative Name

First Last

Second Representative Email

Enter Email Confirm Email

Second Representative Cell Phone

Enter Email Confirm Email

Third Representative Name

This section is to be used by Platinum Level exhibitors only.

First Last

Third Representative Email

This section is to be used by Platinum Level exhibitors only.

Enter Email Confirm Email

Third Representative Cell Phone

This section is to be used by Platinum Level exhibitors only.

Enter Email Confirm Email

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Payment Information

Coupon

Total

Credit Card

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Credit Card Address(Required)

Please enter the billing address for your credit card.

Same as business address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Password

Enter Password Confirm Password

To ensure you have access to your account on this site