FSCCM Exhibitor's Registration

Marco Island Marriot Beach Resort

September 3 thru September 4, 2011

Please complete all information to assure your reservation for display space

Entries with * are required

Company Name:
Contact Person:*

Address:

City:

State:

Zipcode:

Phone:

Fax:

Contact's E-Mail Address:*

Representative Name/s Working Display:

E-Mail Address of Representative/s:
Payment Type:*

Display Fee is $1500.00 Please Make Checks Payable to : Florida Society of Critical Care Medicine

Display hours for the meeting are 7:00 AM - 12:00 Noon each day. Essential times for representatives to be at the displays are 7:00 – 8:00 AM for the continental breakfasts and the midmorning coffee breaks - both being served in the display area. Drawings will be held for Hotel Stays and Gift Certificates. Eligibility for the drawings requires a signature of representatives for all exhibitors. Exhibitors may set up from 4:00 – 6:00 PM on Friday, September 3rd. Any shipment of display equipment or supplies must be cleared through the hotel (239) 394-2511. Name badges are required for entry into the exhibit area. It is important for all exhibitors to complete the entire registration form. This will allow us to provide proper name tags and acquire other information necessary to make our meeting a benefical and pleasant experience.

Room reservations for the meeting may be made directly to the hotel at:(800-438-4373 -reservations only) or by using the Hotel Registration link on the website.

For additional information about the conference or FSCCM Contact

Florida Society of Critical Care Medicine

Charles G. Towater, Executive Director, FSCCM

13012 Whisper Bay Place

Tampa, Florida 33618

Telephone: Charles G. Towater, Exec. Dir. (813)963-3867

Fax: (813)960-4602 E-Mail: fsccm1@verizon.net