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