Exhibitor Registration Illinois Society of Oral and

Exhibitor Registration
Illinois Society of Oral and Maxillofacial Surgeons
Saturday, April 25, 2015; 8 AM to 4 PM
Hamburger University on the McDonalds Campus
2715 Jorie Blvd., Oak Brook, IL 60523
Featuring Lew Estabrooks, DMD, MS: Complications and Pitfalls of Anesthesia and
Edward T. Naureckas, MD: A physiology based approach to Lung Disease
Name of Company _________________________________________________________________________
Address __________________________________________________________________________________
Name of Representative(s) ___________________________________________________________________
_________________________________________________________________________________________
Tel. _________________________________________Email ________________________________________
Each exhibitor will be provided with a table, typically six feet long.
Do you need electricity?
_____ YES _____ NO
Number of meals: _______________________
The registration fee for the educational program on Saturday, April 25, 2015 is $700.00, payable to ISOMS,
and due prior to the program date. The cost of ONE meal is included. Please add $35 for each additional
lunch needed. Make checks payable to ISOMS, and mail to 810 S. Waukegan Road, Ste. 104, Lake Forest, IL
60045. Credit cards can be accepted for and additional $6 fee. Contact the office at 847-482-0222 to use
your Visa, MasterCard or Discover Card. Please mail this form to ISOMS, fax it to 847-574-0445 or email
isoms99@aol.com.
Income from exhibitors is intended to help defray the general expenses of the educational programs. ISOMS
does not endorse any products or services. ISOMS reserves the right to cancel any program due to weather,
travel related problems or speaker cancellation for any reason, with no obligation to any exhibitors. Refunds
of Exhibitor fees will be issued under those circumstances only.
Tax ID 36-2916474
Thank you!
810 S. Waukegan Road, Ste. 104; Lake Forest, IL 60045