3. BADGE ORDER FORM + COMPANY PRODUCT

Internal Use Only: ID Number:
Date Received:
/
/
Assigned Table #:
Initials:
Initials:
Exhibitor Badge Order Form and Exhibitor Listing Information Request Form
Exhibition: Oct 17 - Oct 18, 2016 | Hyatt Regency Huntington Beach Resort and Spa | Huntington Beach, CA
1. Company Description (Due August 5, 2016) : Please submit a brief description, (50 words or less) about your company and any new prodcuts/services that are available.
Provide your Company Information as you would like it listed in the Exhibit Guide. Be advised that your description must be 50 words or less, or it will be edited. Send your description as a
WORD Document to Alison Caballero at caballero@pda.org. No guarantees on any submissions after August 5, 2016. * Required Fields
Check here if you would like us to use your abstract on file.
* Company Name :
* Address
* Telephone (
* City
* Email
* Zip/Postal Code
* State/ Country
2. Exhibitor Listing Information:
o Analytical Equipment
o Analytical Services
o Biological Indicators
o Biological/Vaccines
o Blow-Fill-Seal Systems
o Calibration Services
o Chemical Supplier
o Clean Room Equipment and Supplies
o Clinical Manufacture Services
o Cold Chain Solutions
o Consulting Services
o Container/Closure Systems
o Contract Services
* Fax (
)
)
Twitter Name @
* Website
Check the categories that best describe your company’s products/services.
o Disposable Technology
o Drug-Delivery Systems
o Environmenal Monitoring
o Filtration
o Freeze Drying Systems
o Glass Containers/Glass Products
o Inspection Systems
o Instruments and Controls
o Isolation Technology
o Labeling and Coding
o Logistics/Transportation Services
o Lyophilization Services
o Publications
o QA/QC Services
o Regulatory Compliance
o Single Use Systems
o Software
o Sterile Manufacturing
o Sterilization Systems
o Supply Chain Services
o Testing Equipment/Services
o Training Materials and Services
o Validation Services
o Vials
o Water Systems
o Microbiological Services
o Microbiology Lab Equipment
o Microbiology Services
o Packaging Equipment
o Packaging Supplies/Solutions
o Parenteral Fill Finish
o Parenteral with technology
o Pharmaceutical Equipment
o Prepared Media
o Process Automation
o Processing Equipment
o Product Development Services
3. Each Booth/Table Package includes One Full Conference Pass and One Exhibit Only Pass. Your conference badge names are due by August 5, 2016.
Submit your form to caballero@pda.org . Any submissions/substitutions must be made in writing before August 5, 2016 , after this date a fee of $50 will incur per submission.
Late submissions will incur a $50 processing fee per submission.
Full Conference Registration: (Due August 5, 2016)
* Required Fields
* First Name:
Exhibit Only Registration: (Due August 5, 2016)
* Required Fields
* First Name:
* Last Name:
* Contact Job Title
* Contact Job Title
Address
Address
City/ State/ Zip
City/ State/ Zip
* Phone
* Last Name:
* Phone
Mobile Phone
* Email
Mobile Phone
* Email
SUBMISSIONS/ SUBSTITUTION must be made in writing before August 5, 2016, after this date a fee of $50 will incur per submission. *Complete Rules and Regulations on page 2.
POSTER PRESENTERS: are required to register as a full conference attendee at the prevailing rate. The full conference pass included with a Booth/Table package does not qualify for poster submission. Exhibit
only registrants are eligible to present a poster by registering as a paid full conference participant. In order to be listed i
no later than August 5, 2016.
4. Additional Exhibit Only Badge: payment is required for additional badges.
Additional Exhibit Only Badge: payment is required for additional badges.
* Required Fields
* Required Fields
* First Name:
* First Name:
* Last Name:
* Contact Job Title
* Contact Job Title
Address
Address
City/ State/ Zip
City/ State/ Zip
* Phone
* Last Name:
* Phone
Mobile Phone
* Email
Exhibit Only $500
* Email
5. Credit Card information required to process additional Additional Exhibit Only Badge request:
Please check one. All cards are charged in US$
Bill my:
American Express
Master Card
Visa
Mobile Phone
Total Amount $ __________________
Exhibit Only $500
*Required Fields
Credit Card is a guarantee of payment only
*Card Number ___________________________________________________________*Exp. Date: __________________________________________________________
*Name (exactly as it appears on card:______________________________________________________________________________________________________________
*Billing Address (if different from above) __________________________________________________________________________________________________________
*City/State/Zip/Country________________________________________________________________________________________________________________________
* Signature___________________________________________________________________________________________________________________
Internal Use Only: ID Number:
Date Received:
/
/
Assigned Table #:
Initials:
2016 PDA Universe of Pre-filled Syringes and Injection Devices
Exhibition: Oct 17 - Oct 18, 2016 | Hyatt Regency Huntington Beach Resort and Spa | Huntington Beach, CA
Rules and Regulations on Exhibitor Badge Order Form:
have submitted a purchase order or requested an invoice please be advised that a credit card guarantee is needed.
Please be advised that if your payment or written cancellation notice is not received by August 5, 2016, your credit
card will be charged the prevailing rate.
SUBSTITUTIONS: If you are unable to attend, substitutions can be made at any time, including on site at the
prevailing rate plus a $50 processing fee per name change. Substitutions received after August 5, 2016,
will incure a $50 fee per submission.
ADDITIONAL EXHIBIT ONLY PASSES: May be purchased at any time up until the start date of the conference.
You can purchase an unlimited number of additional exhibit only badges. Note that exhibit badges will allow access
to only the Exhibit Hall/Area and on the Monday, night networking reception.
REFUNDS: Refund requests must be in writing and faxed to +1 (301) 986-1093. (Emails and phone messages
are not accepted). Refunds for Additional Exhibit Only Badges: If your written request is received on or before
August 18, 2016, you will receive a full refund minus a $200 processing fee. After that time, no refunds or credit
requests will be approved. On-site registrants are not guaranteed to receive conference materials until all
advanced registered attendees receive them. PDA reserves the right to modify the material or speakers/instructors
soon as possible and will receive a full refund. PDA will not be responsible for airfare penalties or other costs
incurred due to cancellation. For more details, contact PDA at info@pda.org or +1 (301) 656-5900. Please note
that a photo ID will be required in order to pick up badge materials on-site. This important security procedure will
prevent any one other than the registrant from picking up their badge and materials.
RECORDING/PHOTO RELEASE: By registering for this event, I authorize PDA the right to record and photograph me
to use the recordings/photographs in all formats and media for any purpose, including for education, marketing
and trade purposes. I hereby release PDA from all claims arising out of the use of the recording/photographs,
including without limitation all claims for compensation, libel, invasion of privacy or violation of copyright
ownership.
All prices in US dollars.
Please note: In order to receive the prevailing registration rate, your registration(s) must be received by PDA
by 5:00 p.m. ET on or before the date noted.