Massachusetts League of Community Health Centers



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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