AMISA Partner Registration Form

Partner Exhibitors will be limited to 10 organizations/businesses for the conference. Once spots are full, registration will close. If you would like to be on the waiting list, please email Adam Slaton at adam@amisa.us.

Primary Partner Contact Information

Choose PARTNER MEMBER

FIRST NAME

Last Name

Organization Email

Registration Type (choose one)

Registration includes 1 exhibitor table, conference meals, and conference credentials.

Registration Cost:

$599.00 for first participant (includes table, conference meals, credentials)
$399.00 for each additional representative (includes meals, credentials)

Please choose how many ADDITIONAL REPRESENTATIVES will be attending

PLEASE LIST ADDITIONAL REPRESENTATIVES NAMES AND EMAILS

Billing Option (choose one)

Select an option

CREDIT CARD (an AMISA staff member will contact you with details)

INVOICE ME