Exhibitor Registration Exhibitor Registration Exhibit space will be assigned on a first-come, first-served basis, according to the date the contract and deposit are received. The preferences given for booth location are for guidance and not guaranteed.Company NameTo be used for booth sign. Please put EXACTLY as you wish it to appear in print. Limited to 40 characters. The abbreviations Inc., Co., Corp. will be used. First Time Attendee? YES NO Describe your product or service: Are there any competitors you would prefer not to be close to? Official Exhibit RepresentativeName First Last Title Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Mobile PhoneEmail* Event SelectionPlease choose individual event(s) below. Fees of 3% are added below to offset processing fees.Spring Conference Booth QuantityApril 12 -14, at Sheraton Refuge Hotel, Flowood, MS Price: $824.00 Quantity Annual Meeting Exhibit Booth QuantityJuly 16 – 19, 2023, at Baytowne Conf. Center in Sandestin, FL Price: $1,648.00 Quantity Fall Conference Booth QuantityNovember 16, at Embassy Suites, Ridgeland, MS Price: $824.00 Quantity MAFP Celebrates 75 YearsThis year the MAFP is proud to celebrate 75 years of our organization. We invite you to join our Diamond Club and show your support of Family Medicine. For a donation of $75, your organization will be recognized on our website, newsletters, and at each conference with a Diamond Club ribbon on your nametag. Simply join when you complete the exhibitor application. Funds will be used to promote student and resident interest. Diamond Club Membership Quantity Price: $77.25 Quantity Exhibitor Names and CitiesMAFP will provide 4 complimentary personnel nametags. Each additional nametag is $25.Attendee 1 First Last City, State Attendee 2 First Last City, State Attendee 3 First Last City, State Attendee 4 First Last While in Destin, I will be staying:On Sandestin property, using MAFP Group Rates.On Sandestin property, but not group rates.Off property.Cancellation PolicyIf cancellation becomes necessary, MAFP will work with each exhibiting company to convert funds to sponsorships, or some other solution. Discounts and exhibit space cannot be given to organizations providing unrestricted grant money to the CME program.Agreement* I have read and agree to pay exhibit fee and abide by information in this Prospectus and Invitation to Exhibit on regulations governing exhibitors. PaymentPlease make sure you have read the application. Space will be charged in accordance with the application. No space will be assigned without a deposit of 50% of the total cost. Note: No booth assignments will be made until these conditions are met. No company will be allowed to set up their exhibit until full booth fee payment has been received by the MAFP.Total Due $0.00 Credit CardCard Details Cardholder Name Post Custom Field CommentsThis field is for validation purposes and should be left unchanged. Δ Full MAFP Rules and Regulations for Exhibitors can be found here.