2024 PGC Exhibitor Registration | Oregon Academy of Ophthalmology

Today's Date
MM slash DD slash YYYY
Company Name*
Primary Contact*
First Last
Title*
Email*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Exhibitor Badge Information
Name (first & last) Email Cell Phone
Do you need electricity?*
- Yes
- No
Please list any companies you prefer not to be next to:
Payment Information
2024 Exhibitor Levels*
- Platinum - $2,000 (includes 4 badges)
- Gold - $1,500 (includes 2 badges)
- Silver - $1,200 (includes one badge)
EXHIBITOR MATERIALS:
Additional Representatives - $100 each
Total
$0.00
REQUIRED FORM: By completing and submitting this Commercial Support Agreement, the company representative has read and agrees to abide by all Oregon Academy of Ophthalmology exhibit practices and regulations. Please email or fax this signed agreement to (503) 210-1533.
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

Cancellations will be charged a $100 service fee. No refunds after February 1, 2023.

Name (first & last)	Email	Cell Phone

Payment Information