EmailMe Form - Wisconsin Perfusion Society

Wisconsin Perfusion Society - Vendor Registration

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$750 Vendor Fee Includes:

- Three company representatives to attend The 30th Annual (2024) Wisconsin Perfusion Society Spring Meeting in Milwaukee, Wisconsin
- One skirted table and chairs
- One electric power strip and extension cord or combination of both

Additional tables may be added for a fee of $500 each

Additional representatives may be registered for a fee of $100 per individual

Company *
Contact Name *
Prefix First Last Suffix
Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Preferred Email *
Preferred Phone Number *
### - ### - ####
2nd Representative Name
First Last
3rd Representative Name
First Last
Additional Vendor Table
Yes
Number of Additional Vendor Tables Needed *
1 Additional Table
2 Additional Tables
3 Additional Tables
Additional Company Representative Registration(s)
4th Representative Name *
First Last
5th Representative Name *
First Last
6th Representative Name *
First Last
7th Representative Name *
First Last
Questions and/or Comments (Dietary Allergies / Requests)