BROWARD COUNTY DENTAL ASSOCIATION
1919 NE 45 Street, Suite 216
Ft. Lauderdale, FL  33308
TELEPHONE: 954-772-5461     FAX: 954-772-0553

Meeting Sponsorship Agreement

It is hereby agreed that we will sponsor meetings of the Broward County Dental Association (BCDA) based on the fee schedule below:

Sponsorship Cost
Dinner Meeting Sponsorship $200
Mandatory Course Meeting Sponsorship $250
Half-Day Seminar Sponsorship $300
All-Day Seminar Sponsorship $500
Additional representatives from each company will be charged $50.00 per person for the included meal.

In return, the Broward County Dental Association (BCDA) will provide us with a notice in their publication, the Broward Dental Review, naming our company as a sponsor.

We will also be provided space, including tables, to exhibit our product/services prior to and during the meeting. One complimentary meal will be provided for the exhibitor.

Name of Company:

Product/Services:

Mailing Address:

City:    State:    Zip:

Contact Person:    Phone:

Meeting Date(s):

Will there be additional representatives from your company?
No   Yes     If so, how many?

________________________________________
Authorized Signature

__________
Date

BCDA must receive sponsorship fee prior to meeting.

Meeting Sponosrhip Agreement Submission: Select method of choice
(1) Complete form above, Pay for Sponsorship via PayPal, and Submit... Print Form for your records.
(2) Complete form, Print Form for faxing or mailing with payment... Print Form for your records.
NOTE: A signed form must be faxed or mailed to us for our records  if initially submitted on line.