Georgia Heart & Vascular Symposium

Georgia Heart & Vascular Symposium Sponsorship Form
Company *
Contact name *

First Name Last Name
Title/Role *
Phone Number *

Area Code Phone Number
Email *
Sponsorship Package *

Platinum Heart ($10,000) Golden Heart ($7,500) Silver Heart ($5,000) Giving Heart ($2,500)
Total number of staff attending with exhibit *
Will you need an electrical outlet for your exhibit booth? *
Total number of staff attending with Simulation Program
Size of Simulation Program space needed
Will you submit a 30-Second commercial?
Names of Gala attendees (2 max.)
Agreement & Authorization
I have read the terms and conditions and agree to comply with the Standards for Commercial Support and have reviewed the payment terms. I certify that the exhibit funds have been secured or authorized and will be paid on or before May 24th, 2022. I am authorized to approve the terms of this contract.
Authorized Signature

Clear
Today's Date

Month Day Year
Should be Empty:

Georgia Heart & Vascular Symposium Sponsorship Form