2007 AMBA Exhibitor Registration

 

Business Name ___________________________________________________

 

Contact Person ___________________________________________________

 

Address _________________________________________________________

 

City ________________________________State __________Zip ___________

 

Work Phone _________________________Fax _________________________

 

Email _________________________Website ___________________________

 

Name(s) of Exhibitors to appear on badge(s)(First two Reps included, $50 for each addl/)

________________________________________________________________

 

________________________________________________________________


________________________________________________________________


________________________________________________________________

 

Product/Service Description for Conference Brochure and Website (25 Word Limit) ________________________________________________________________

 

________________________________________________________________

 

________________________________________________________________

 

Exhibitor Fee Enclosed $____________

($1,000 if before August 31, 2007 - $1,250 if after August 31, 2007)



Exhibitor's Hotel Reservation Confirmation # _____________________________

Will you bring your own booth and if so, will you still need a table? ___Bringing booth
Table Required ___Yes ___No

 

Payment Information


Charge my     ___Visa     ___MasterCard     ___Discover     ___American Express


Card #__________________________________ Exp. Date_______________ 


Cardholder Name_________________________________________________

Signature________________________________________________________
(Charge will appear as AMBA)

Make Checks Payable to

AMBA · 4297 Forrest Drive · Sulphur, OK 73086


Fax Credit Card Registrations to: (580) 622-5810


Exhibitor hereby covenants and agrees to save and hold the American Medical Billing Association, (AMBA), the Harrah's Hotel and Casino (“Hotel”), subsidiaries, affiliates, officers, directors, shareholders and employees free clear and harmless from any and all liability, lost, costs, expenses (including attorney’s fees), judgments, claims and demands of any kind whatsoever in connection with, arising out of or by reason of any act, omission, or negligence of Exhibitor or its respective agents, employees, servants, or contractors in any way connected with or arising out of any accident, injury or damage, whether to person or property, whatsoever, occurring before, at, in, upon, about, after, or in any manner connected with the convention at Harrah's Hotel and Casino, Las Vegas in connection with this event. Exhibitor acknowledges that neither the Hotel, hotel operator, nor AMBA maintain insurance covering exhibitor’s property and the exhibitor must obtain business interruption and property damage insurance sufficient to cover any loss sustained by exhibitor.

 

Exhibitor Signature ________________________________Date ____________


Questions? Call our Conference Coordinator at (580) 622-2624 or email Larry@brightok.net

 

The American Medical Billing Association will not accept liability for damages of any nature sustained by exhibitors or their accompanying persons or loss of or damage to their personal property as a result of the Conference or related events.