25th NORTHEAST REHAB SYMPOSIUM

Exhibitor Registration Form

Fill out form below or print and mail Exhibitor Registration Form PDF

Company Name

Attendee Name

First Last

Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Representative 1

Name

First Last

Title

Phone

Representative 2

Name

First Last

Title

Phone

Both Contact and Representatives will Receive Confirmation Email

*Refunds will be issued up to 2 weeks before the symposium (less a $10.00 cancellation fee per individual). Deadline for vendor registration and payment: Friday, October 14, 2022 This reservation form is executed by the undersigned as an authorized representative of the above named company.

Exhibitor Registration $425 due 10/14/2022

I hereby request a reservation for an exhibit booth for the 25nd Annual Northeastern Rehabilitation Symposium to be held at The Hotel & Conference Center at Mohegan Sun in Wilkes-Barre, PA on Thursday, October 27, 2022. I understand that booth locations will be reserved on a first come-first serve basis and that no booth will be reserved without remitting a non-refundable fee. If you have any questions, please contact Bill Dempsey at wdempsey@nerehab.com or (570) 344-3788 ext 320.

Electrical Requirements:(Required)

(Additional $25.00):

I DO NOT need Electricity ($425 total)

I DO need Electricity ($450 total)

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Updates for Clinical and Legal Practice

The Hotel & Conference Center
at Mohegan Sun
1280 Highway 315, Wilkes-Barre

Thursday, October 27, 2022
8:00AM – 4:30PM

Attendee Registration Form

PAYMENT:

Exhibitor Registration Form

Both Contact and Representatives will Receive Confirmation Email

Exhibitor Registration $425 due 10/14/2022

Hassle Free Appointment Requests

570.344.3788

* New Patients Only