§ FAX THIS FORM WITH CREDIT CARD PAYMENT TO: 703/739-1321; § OR MAIL A CHECK TO: MIDWEST-ASCP,

1321 Duke St., Alexandria, VA 22314-3563 THANK YOU FOR YOUR SPONSORSHIP

CORPORATE RESPONSE FORM Company Name: __________________________________________________________________ Representative:____________________________________________________________________ Phone #: ___________________ E-Mail: _____________________________________________ Authorized Representative Signature: _______________________________________________________

(must be signed to be accepted by ASCP) PRODUCT THEATERS £ FRIDAY, JULY 14TH

Dinner Product Theater - $2,500

£ SATURDAY, JULY 15TH Breakfast Product Theater - $2,500

£ SATURDAY, JULY 15TH

Lunch Product Theater - $4,000

£ SATURDAY JULY 15TH

Off-Site Dinner Product Theater - $2,500

£ SUNDAY JULY 16TH Breakfast Product Theater - $2,500

For all Product Theaters: ASCP will provide the following: banquet room, podium, podium microphone and wireless lavaliere. A LCD projector is also available on request. The product theater sponsor is responsible for the speaker expenses and the cost of the meal. New! EXHIBIT TABLE PLUS PRODUCT INFORMATION / NETWORKING SESSIONS £ SATURDAY, JULY 15th - Afternoon

Exhibit plus session - $1,250.00

£ SUNDAY JULY 17TH - Morning Exhibit plus session - $1,250.00

£ Exhibit / Display Table – $ 1,000.00 TAX ID#52-0942322 £ A Check Is Being forwarded to Midwest ASCP £ Send Me an Invoice Credit Card Payments

$________________ to £ MasterCard £ VISA £ AMEX £ Discover Card # ___________________________________ CSV Code# __________Exp. Date _________ Address Associated with Card: _____________________________________________________ Printed Name: ___________________________ Signature: ______________________________ Cancellation Policy: Display booths cancelled before Friday May 26, 2017 will be refunded 50% of fee paid. No refunds will be issued for booths cancelled after Friday May 26, 2017.