Contact First Name
Contact Last Name
Please indicate which categories best describe your products and/or services. (Check all that apply)
Billing (Software or Services)
Chairs or Other Podiatric Equipment
Electronic Medical Records
Implants and Surgical Devices
Laboratory and Diagnostic Services
Orthotics and Corrective Devices
Standard Convention Sponsor ($700)
Premium Convention Sponsor ($900)
Notepad Sponsor ($500)
Pen Sponsor ($500)
Pen Sponsor (In-Kind)
Lanyard Sponsor ($500)
Lanyard Sponsor (In-Kind)
Registration Bags ($750)
Registration Bags (In-Kind)
Advertising for On-site Program
Full page ($300)
Half page ($200)
Full page - Standard Sponsor ($225)
Full page - Premium Sponsor ($150)
Half page - Standard Sponsor ($150)
Half page - Premium Sponsor ($100)
On-site Representative First Name
On-site Representative Last Name
On-site Representative Email Address
Would you like to register an additional company representative?
Yes (Additional representative - $75)
No (Additional representative)
Additional Representative First Name
Additional Representative Last Name
Additional Representative Email Address
List any company that you prefer your table is not next to at the convention. Requests will be honored, if possible.
Will you need electricity?
Set-up and Teardown
By registering for a display table at the 2021 IPMA Fall Convention, I agree to be set up by 11:30 a.m. on Thursday, October 14 and will not teardown before 3:00 p.m. on Friday, October 15.
Requests for refunds must be made in writing to IPMA. Cancellations made prior to September 23, 2021, will be refunded minus a processing fee of $40.
I agree that by registering for the IPMA Fall Convention to be held October 14-17, 2021, at Ascension St. Vincent William K. Nasser, M.D. Healthcare Education and Simulation Center, Indianapolis, IN, I am aware and understand the risks associated with the COVID-19 pandemic. I will indemnify and hold harmless the Indiana Podiatric Medical Association, its volunteers, employees, and others working on behalf of the Indiana Podiatric Medical Association, against any and all claims, demands, suits, or loss, including all costs connected therewith, and for any damages which may be asserted, claimed, or recovered against or from the Indiana Podiatric Medical Association, including loss of life, as a result of the pandemic.