*Company Name: ______________________________________________________________

*Contact Person: ________________________________ TITLE: ________________________

Contact Person’s Home Address: __________________________________________________

City: __________________________________ State: ___________ Zip Code: ______________

EMAIL: _________________________________ Home Phone: ( _____ ) _____ - ___________

Are you (being the contact person) attending the exhibit? ____ Yes  ____ No

____ Premier Support ($1,500)
(includes premier exhibit location; space as needed; display banner; program acknowledgement; food and beverage passes for up to six individuals)

____ Priority Support ($1,000)
(includes priority exhibit location; double space if needed; program acknowledgement; food and beverage passes for up to four individuals)

____ Exhibitor Support ($500)
(includes standard tabletop space; program acknowledgement; food/beverage passes for two people)

PLEASE NOTE: All exhibitor applications and payment in full must be received by June 1, 2010.
Neither SATNET or the Starr Pass Resort is responsible for any exhibitor property at event.

Do you need electricity? ____ YES (if yes, please add $50.00 to amount)  ____ NO

Products, equipment or services to be exhibited and/or donated: ____________________________________________.

Please list below all others who will be attending from your company. Please add $25.00 per person per day for food and beverage if the number exceeds that which is outlined for each support level.

Names: (1)____________________(2)____________________(3)____________________(4)____________________

$ _____________  Level of Support

$ _____________  Electric

$ _____________  Additional (Food)

$ _____________  TOTAL ENCLOSED

PLEASE MAKE CHECK PAYABLE TO: SOUTHERN ARIZONA TRAUMA NETWORK (SATNET)

Send Check to:
Clint Brown, Program Director
Southern Arizona Trauma Network
P.O. Box 43818
Tucson, AZ 85733-3818
(520)795-2170   email: clbsatnet@aol.com