Americas Hernia Society

Advancing the Science and Treatment of Hernia

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Marketing and Visibility Opportunities Confirmation Form

Company Name*
Please enter exactly as you want it printed in programs and on name badges.
Name*
First Last
Title*
Email*
Phone*
Website*
Please enter http:// before your web URL
Visibility Tiers*
All packages are on a first-come, first-served basis and are only available to Corporate Alliance members, except where otherwise noted.
- Diamond (1 available)
- Platinum (5 available)
- Gold (5 available)
- Silver (Non-Members Only)
- Silver
- I do not wish to purchase a visibility package.
A La Carte Marketing Opportunties
Please choose any add-on opportunities you'd like to purchase in addition to your visibility tier purchase.
- Hotel Key Cards (plus production and hotel fees)
- Doctor's Bag Insert
- Custom GOBO (plus set up costs)
- Charging Station (plus production fees)
- Pre-Registration Mailing List
- Mobile Banners - Meeting App
- Push Notifications - Meeting App
- Elevator Door/Escalator/Window/Wall/Carpet Clings (a staff person will contact you to coordinate)
- Name Your Own Sponsorship (a staff person will contact you to coordinate)
Total
$0.00
Method of Payment*
- Credit Card
- Check
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card*
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.

If you wish to create a payment plan or have questions about the visibility tiers, please contact jenay@americasherniasociety.org.

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The Americas Hernia Society

Advancing the science and treatment of hernia

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Contact the AHS

11300 W. Olympic Blvd, Suite 600
Los Angeles, CA 90064

(310) 730 - 5596

info@americasherniasociety.org

Monday - Friday:
8:00 am - 5:00 pm Pacific Time

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