Fall Intensive Booth Registration Fall Intensive EXHIBIT Form Company NameContact Name First Last Mobile PhoneFAXEmail Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Electricity Needed?YesNoWill you be staying overnight at the Westin?YesNoFirst-Time Attendee at MAFP Event?YesNoHow did you hear about us?Booth Cost: Price: $ 700.00 Quantity: Cancellation PolicyCANCELLATION POLICY: If a space is canceled after October 1, 2019, full payment for space will still be due and payable. If cancellation becomes necessary, MAFP will refund one-half of the exhibit fee ONLY IF WRITTEN PRIOR to October 1, 2019. If space is not paid for in full by October 1, 2019 it may be reassigned to another exhibitor at the option of the MAFP Professional Development Committee. Discounts and exhibit space cannot be given to organizations providing unrestricted grant money to the CME program. The exhibit fee is $700. RULES/REGULATIONS: Any company which reserves a booth space and does not inform MAFP of its plans for non-attendance will not be permitted to participate in future MAFP exhibitions and will also forfeit 100% of the total cost of the exhibit space assigned. I have read and agree to the cancellation policy above.*Read and AgreedTotal $ 0.00 Payment Method*Check to be mailed to MAFP by Oct. 1, 2019Credit Card (call 601-853-3302 to pay)NameThis field is for validation purposes and should be left unchanged.