Southern States Rhinology Course

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REGISTER TO SUPPORT THE SSR

Company Name

Contact Person (req.)

Address

City, State  Zip

E-mail (req.)

Office Phone

Mobile Phone

Fax

YES, we would like to support the SSR at the following Patron Level

 

Platinum Patron - $10,000

Gold Patron - $7,500

Silver Patron - $5,000

Bronze Patron - $3,000

 

All SSR Patrons are eligible for an exhibit table at the SSR Course, October 21-24, 2009 at Kiawah Island Golf Resort AND a listing on the Patron Page on the SSR website until November 30, 2009.  Yes, we will be exhibiting at the meeting

 

 

We are unable to support the SSR as a patron but wish to exhibit at the 2009 SSR Course - $2000

We'd also like to contribute to the following:

 

Program Printing ($1000 min.)

Continental Breakfast ($2000 min.)

Coffee Breaks ($1000 min.)

Lunch ($3000 min.)

All support will receive acknowledgement on printed meeting materials as well as our website.  A small sign to place in the area of the event is welcomed.

Exhibitor Badge Names

 

Social

Yes, we will attend the SSR Course Thursday evening cocktail party

Number attending

 

YES, I am interested in playing golf with other attendees and/or exhibitors. I understand that the tee time will be made in my name, and I will be responsible for all charges and cancellation policies.

Name:   Handicap:

Name:   Handicap:

 

I want to play Thursday afternoon.

I want to play Friday afternoon.

 

Please indicate a course preference (Ocean Course, Turtle Point, Osprey Point, Oak Point, Cougar Point)

Payment

Our total commitment comes to  $

After you submit this registration, a link will appear to pay with a credit card via PayPal online. If you would prefer to pay with a check, please mail it in with the PDF invoice (linked on next page) in order to complete this registration.

Additional Comments

This registration will go directly to Tara Morrison, the SSR Executive Director.  If you have any questions, you can contact her at 770-613-0932 or tara@theassociationcompany.com  And don't forget to make your room reservation, (800) 576-1570.

770-613-0932 | 305-422-3327 fax | 6134 Poplar Bluff Circle, Suite 101, Norcross, GA 30092 | alice@theassociationcompany.com | Terms and Conditions

last updated March 14, 2008