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- If you would like to request display space for your company, please print and fill out the
form below and mail to:
American Society of Dermatology
411 Hamilton Blvd., #1006
Attn: Monica L. Craig
Peoria, IL 61602
If you have any questions
please feel free to contact us at 309/676-4074 or for faster
response send email to ASD. If we hear from you at an early date,
appropriate recognition will be given in our registration material.
For your records, our Federal Tax I.D. number is 73-1401658.
American Society of Dermatology
8th Annual Meeting
Newport, Rhode Island
October 1-3, 1999
Hotel Viking
Exhibitors Display Request Sheet
____ YES, our company wishes to make an educational support contribution to the
American Society of Dermatology's 8th Annual Meeting in the amount of
$________________ but we do not wish to display. Enclosed is our check for
same.
____ YES, our company would like to make an educational support contribution and
would also like to display. Enclosed is our check in the amount of
$_______________. (A confirmation regarding your display space will be made
upon receipt.)
Please list a Contact name, Company name,
Address, Telephone
and Fax Information Below:
_____________________________________________________________
Contact Name
_____________________________________________________________
Company Name
_____________________________________________________________
Street Address
_____________________________________________________________
City, State, Zip
____________________________________________________________
Telephone Number/Fax Number
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