2020 Winter Meeting Exhibitor Registration 2020 Winter Meeting Exhibitor Registration JANUARY 10-12, 2020 Hilton Whistler Resort & Spa Whistler, BC Please complete the form below to exhibit at the NWAO Winter Conference or... Maximize Your Presence … Take advantage of these exhibit level opportunities! EXCLUSIVE LEVEL OPPORTUNITIES AVAILABLE: Your 2020 Exhibit Package includes an exhibit booth, acknowledgements in the conference e-syllabus, electronic attendee list prior to the meeting, complimentary breakfast and breaks for four representatives PLUS ADDITIONAL BENEFITS AS OUTLINED BELOW! DIAMOND EXHIBITOR $10,000 Opportunity to showcase your product (Up to 10 minutes), company logo printed on cocktail napkins used during the break, verbal recognition from the podium, company signage prominently displayed in Exhibit Hall, print acknowledgement on “Passport”, and your booth will be a mandatory stop for attendees as they collect stamps from booths to win a raffle prize. GOLD EXHIBITOR $7,500 Attendees will have phone chargers available at/adjacent to your booth, verbal recognition from the podium, company signage prominently displayed in exhibit hall recognizing you as Gold Exhibitor and encouraging visit to your booth, your booth will be a mandatory stop for attendees as they collect stamps from booths to win a raffle prize. SILVER EXHIBITOR $5,000 Verbal recognition from the podium, company signage prominently displayed in Exhibit Hall recognizing you as a Silver Exhibitor, print acknowledgement on “Passport”, and your booth will be a mandatory stop for attendees as they collect stamps from booths to win a raffle prize. Company Information Company Name* Company Website Primary ContactPrimary Contact Name* First Last Primary Contact Title Primary Contact Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Primary Contact PhonePrimary Contact Email* Primary Booth Representative Contact(This information will be published and distributed to attendees)Primary Booth Representative Information Information is the same as Primary Contact Primary Booth Name First Last Primary Booth Rep Title Primary Booth Rep Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Primary Booth Rep PhonePrimary Booth Rep Email Representatives Staffing Your Booth Two allowed with exhibitor booth only, additional representatives $150 each. Four allowed with support package.Booth Rep 1 First Last Booth Rep 2 First Last Booth Rep 3 First Last Booth Rep 4 First Last Exhibit Space InformationExhibit space will be assigned based on level of sponsorship, exhibit location purchased, followed by first come basis.Product/Service to be DisplayedPlease indicate companies, if any, you desire NOT to be located adjacent to (i.e. competitor)Competitors/CompaniesAgreement for Participation & Conduct by Commercial Interests at CME Activities The Accreditation Council for Continuing Medical Education (“ACCME”) defines a Commercial Interest as “any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME does not consider providers of clinical service directly to patients to be commercial interests.” _________________________ (“Company”) agrees that it is an ACCME defined Commercial Interest and thereby agrees to the following in conjunction with a CME activity accredited by the Washington State Medical Association (WSMA) and the joint provider Northwest Academy of Otolaryngology: Arrangements for commercial exhibits and/or promotional activities and/or In-Kind Support cannot influence planning or interfere with the presentation, nor can they be a condition of the provision of commercial support for the CME activity. Exhibit and/or Promotional Activity fees are not considered commercial support of the CME activity and will not be acknowledged as educational grants. The Company must be granted prior approval from the WSMA if the Company desires to provide funds or in-kind support for the use of social events and/or promotional activities. Such funds are considered to be commercial support, which requires a separate Letter of Agreement. The Company must provide all funds approved for such events to the WSMA, or, when applicable, to its Joint Provider, for distribution. No other payments shall be given to the director of the activity, planning committee members, teachers or authors, Joint Provider, or any others involved with the supported activity. Live (staffed exhibits, presentations) or enduring (printed or electronic advertisements) promotional activities must be kept separate from CME. Social events or promotional activities at the CME activity cannot compete with or take precedence over the CME activity. Industry-sponsored social events or promotional activities, including Company-sponsored social events or promotional activities, must be approved by the WSMA, even if the events are off-site. The WSMA reserves the right to refuse exhibit space or promotional activity space for any reason. The WSMA reserves the right to close an exhibit or promotional activity for any reason. In addition, any representatives of Company who conduct themselves unethically or outside the guidelines provided by the WSMA may be asked to remove their Company’s exhibit. The Joint Provider can exercise these rights on behalf of the WSMA if the WSMA is not present. Adherence to Guidelines – It is the responsibility of Company to distribute the guidelines below to all Company representatives attending the CME activity and/or working the exhibit space. Company agrees that its actions, and the actions of its representatives, shall not violate the following guidelines: Product-promotion materials or product-specific advertisement of any type is prohibited in or during CME activities. Advertisements and promotional materials cannot be displayed or distributed in the educational space immediately before, during or immediately after the CME activity. Educational materials that are used during a CME activity cannot contain any advertising, corporate logo, tradename, or a product group message of an ACCME defined commercial interest. Representatives of Company can attend the CME activity at the discretion of the WSMA or Joint Provider but cannot engage in sales or promotional activities while in the space of the CME activity as determined by the WSMA or Joint Provider, if applicable, consistent with the ACCME guidance. Representatives of Company must remove their company name badges and anything with a corporate logo, tradename or a product group message while in the educational space of the CME activity. Representatives of Company cannot act as agents providing CME to learners. Conditions & Guidelines Agreement Statement: The Company, WSMA and its Joint-Provider (if applicable) agree to abide by all requirements of the ACCME Standards for Commercial Support. Duration: This agreement shall remain in effect until one or more parties terminate the agreement in writing. Company Name* Signature* First Last Exhibitor Registration Rates2020 Winter Meeting Exhibiting LevelsExhibit booth space included with all exhibit levels. Exhibit Booth Space - $3000 Diamond Exhibitor - $10,000 Gold Exhibitor- $7,500 Silver Exhibitor - $5,000 Additional Booth Representatives - OptionalTwo allowed with exhibitor booth only, additional representatives $150 each. Four allowed with support package.Select # of addt'l booth repsOne additional rep - $150Two additional reps - $300TOTAL $0.00 Upon completing the form and clicking "submit," you will be directed to PayPal to make the exhibit payment to the NWAO. You do not need a PayPal account to make a payment. INQUIRIES: Becky Constantine, Exec. Director, NWAO Phone: 206-956-3635; Fax: 206-441-5863; Email: admin@nwao.org Δ