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Sponsor Registration
Please complete this form to register for the 2024 Summer Conference. For assistance, please contact Geri Root, MPMA Director of Events at 517-999-8751 or geri@kdafirm.com.
To view the MPMA Summer Conference sponsor information,
click here
.
Please select the item that best describes your products or services.
*
🛈
Ambulatory Devices
Anesthesia
Billing Software or Services
Chairs and Other Podiatric Equipment
Computer Software
Electronic Medical Record
Diagnostic Equipment
Implants and Surgical Devices
Instruments
Laboratory and Diagnostic Services
Medical Supplies
Office Supplies
Orthotics and Corrective Devices
Shoes
Wound Care
Other
If you selected "other," please describe
Company
*
Contact First Name
*
Contact Last Name
*
Address
*
City
*
State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Belgium
Zip Code
*
Phone Number
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Email Address
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Company Website Address
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Sponsor Registration
Conference Sponsor ($500)
Do you need electricity?
*
Yes - Electricity
No - Electricity
Company Logo
Please upload a high resolution file of your company's logo. Preferred format is JPG or EPS. We cannot use files saved from websites, scanned logos, or word documents.
On-Site Representative First Name
*
On-site Representative Last Name
*
Representative Email Address
*
Conference Participation
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I will attend on Friday only
I will attend on Friday and Saturday
Saturday Breakfast Registration
*
Yes, I will attend breakfast on Saturday
No, I will not attend breakfast on Saturday
Current Total:
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