Business Name
___________________________________________________
Contact Person
___________________________________________________
Address _________________________________________________________
City
________________________________State __________Zip ___________
Work Phone
_________________________Fax _________________________
Email
_________________________Website ___________________________
Name on
Sponsorship Sign
_________________________________
Product/Service Description for Conference Brochure and Website (25 Word Limit)
________________________________________________________________
________________________________________________________________
________________________________________________________________
Total Sponsorship Fee Enclosed $__________
Charge my ___Visa
___MasterCard ___Discover ___American Express
Card
#__________________________________
Exp. Date_______________
Cardholder Name_________________________________________________
Signature________________________________________________________
(Charge will appear as AMBA)
AMBA
· 4297 Forrest Drive
· Sulphur, OK 73086
Fax Credit Card Registrations to: (580) 622-5810
Sponsor
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 Sponsor 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.
Sponsor 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
sponsor.
Sponsor
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 sponsors or their accompanying persons or loss of or damage to their personal property as a result of the Conference or related events.