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Massachusetts League of Community Health Centers

Community Health Institute

Exhibitor Registration Form

MAY 10, 2012

Resort and Conference Center at Hyannis, 34 Scudder Avenue, Hyannis

Table Exhibit Fee - $600

Contact person who is filling out this form: ______________________________________________________

Name of person attending the Exhibit Fair:______________________________________________

Title _________________________________________________________________________________________

Organization __________________________________________________________________________________

Address ____ __________________________________________________________________________________

City _______________________________ State __________________ Zip_______________________________

E-mail address ________________________________________________________________________

Phone _________________________________ Fax ___________________________________________________

Badge Name(s) of Trade Show Representatives. Please give the names of up to two representatives for the booth – after two there is a $50 charge per person

❑ My check is enclosed and made payable to Massachusetts League of Community Health Centers.

Please return your registration form and $600 payment by April 18, 2012 to:

Massachusetts League of Community Health Centers, 40 Court Street, 10th Floor, Boston, MA 02108. Any questions please call or email Denise McCauley at 617-988-2244 or dmccauley@ Fax number: 617-426-0097

Table registration includes: one-six-foot table and chair, luncheon for two booth representatives and an opportunity to attend conference sessions on Thursday.

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