FPRR| Vendor Registration

Before Proceeding | Please read the following carefully

The following contract must be uploaded and submitted with your payment — the W9 is for your records. If you are paying by check, you MUST include this contract in the mail ( You can click the below links to download the appropriate form ). For more information, click here to view an information letter.

W9 Form (this is just for your records)
Vendor Contract (you will need to fill this out and return it to us)

A Note About Registration

Pursuant and subject to terms and conditions set forth in this contract, the undersigned desires to display on Friday, February 8, Saturday, February 9, 2019 between 7:00 a.m. – 5:00 p.m. and/or Sunday, February 10, 2019 between 7 a.m. – 2 p.m. during The Twenty-Fourth Annual Family Practice Review and Reunion at Sinclair Community College Conference Center (Building 12) in Dayton, OH. The FPR&R reserves the right to assign exhibitors to the best space available and to make reasonable shifts in location for the benefit of the exhibitor and the betterment of the entire exhibit. Display price is $1,000 per table for 2 days, $500 per table for 1 day or $300 for Sunday only. Deadline for payment/commitment is due by Monday, January 28, 2019.

Company Info
Exhibitor Company Name*
Exhibitor Company Name
Company Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Company Phone*
Company Phone
Personal Info
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Phone
Fax Number
Fax Number
Email*

Email
Have you already submitted a vendor contract?
Have you already submitted a vendor contract?*
- Yes
- No
Upload Your Completed Contract*
Upload Your Completed Contract
Table Reservation
FPRR 2018 Vendor Table Reservation
Option*
- Reserve a table for 1 day
- Reseve a table for 2 days
- Reserve a table for Sunday
- Pay offline
Paying Offline

Make Checks Payable To
Grandview Hospital Foundation

Mail Checks To
Jennifer Horvath - Academy Office
c/o Grandview Hospital and Medical Center
405 Grand Avenue, Dayton, OH 45405
Total
$0.00
Payment

When you click Submit you'll be directed to Paypal where you can securely enter your payment details and finish registration.

If you do not have a Paypal account you can easily pay via credit or debit card without needing to make an account, simply select that option!

Before Proceeding | Please read the following carefully

A Note About Registration

Company Info

Personal Info

Table Reservation

Paying Offline

Payment