26th NORTHEAST REHAB SYMPOSIUM

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: September 29 2023 This reservation form is executed by the undersigned as an authorized representative of the above named company.

Exhibitor Registration $375 due 9/29/2023

I hereby request a reservation for an exhibit booth for the 26nd Annual Northeastern Rehabilitation Symposium to be held at The Hotel & Conference Center at Mohegan Sun in Wilkes-Barre, PA on Thursday, October 5, 2023. 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.

Registration(Required)

Total

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

26th NORTHEAST REHAB SYMPOSIUM