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6 Business Name: Contact Person(s): Address: (must match credit card billing address) City: State: Zip Code: Work #: Fax #: for Contact Person(s): Website: Check all below that apply [ ] Exhibitor agrees to the general information and contract to exhibit section of this invitation. Authorized Company Rep Signature: Date: [ ] included Exhibitor Rep #1: [ ] included Exhibitor Rep #2: [ ] add $175 Exhibitor Rep #3: [ ] add $175 Exhibitor Rep #4: [ ] add $175 Exhibitor Rep #5: Tell us about your company for our brochure & website (25-word limit): Amenities: [ ] included Bringing Exhibitor Booth [ ] included 1 Table [ ] included 2 Chairs [ ] Fee$ may apply 1 Extra Chair [ ] Fee$ may apply 2 Extra Chairs [ ] Fee$ may apply 3 Extra Chairs [ ] Fee$ may apply Electrical Access [ ] Fee$ may apply Internet Access [ ] Fee$ may apply Telephone

7 Application to Exhibit Continued Sponsorship Opportunities: (in addition to your exhibitor package fee) AMBA provides sponsorship opportunities to each exhibitor to allow said exhibitor to stand out. Every exhibitor that participates in a sponsorship will receive special recognition during the conference, in conference brochures, and on AMBA s website. AMBA will allow non-exhibitor sponsors for those companies that cannot exhibit at the conference. [ ] Exhibitor will participate in a sponsorship. [ ] Exhibitor will not participate in a sponsorship. [ ] My company cannot exhibit at the conference but would like to participate in a sponsorship. Company Name to be displayed on special sponsorship sign: [ ] Gold Sponsorship $3,500 Pre- and Post-Conference Attendee List Full Page Ad in Conference Brochure Recognition in Post-Conference Webinar Series (available to all AMBA s online customers) Special Gold Sponsor Recognition (during conference, on conference brochures, & on AMBA s website for 1 year) 1 blast specifically about your company (sent to everyone in our member database of 17,000 people) 3-month ad in AMBA s monthly newsletter 2 Free Additional Exhibitor Rep passes Your company s logo featured on a professional sign displayed throughout the duration of conference. Custom Swag Tote Bags (Non-Stop Recognition 1 for Every Attendee!) Custom Tote Bag Features Sponsor Name & Logo [ ] Silver Sponsorship $2,500 Pre- and Post-Conference Attendee List ½ Page Ad in Conference Brochure Special Silver Sponsor Recognition (during conference, on conference brochures, & on AMBA s website for 1 year) 1 blast specifically about your company (sent to all conference attendees) 1-month ad in AMBA s monthly newsletter your company s logo featured on a professional sign displayed throughout the duration of conference. Conference Attendee Lanyard You pick color! (1 per attendee attendees must wear during conference and your logo will be on it!) Custom Lanyard Features Sponsor Name & Logo. You pick the color!

8 Application to Exhibit Continued Bronze Sponsorship (Options vary select below) [ ] Networking Social Meet & Greet Day 1 at 6:00pm $1,500 Conference Attendee List ¼ Page Ad in Conference Brochure Special Bronze Sponsor Recognition (during conference, on conference brochures, & on AMBA s website for 1 year) Only the sponsor of the Social Event it allowed to attend with attendees. All other exhibitors and sponsors are not permitted to attend. Your company s logo featured on a professional sign displayed during social event. Choice of the following social event prizes (prize will be awarded during event). [ ] Apple ipad 32GB [ ] Apple Watch S3 [ ] Lenovo Ideapad [ ] Daily Luncheon Break $1,500 Conference Attendee List ¼ Page Ad in Conference Brochure Special Bronze Sponsor Recognition (during conference, on conference brochures, & on AMBA s website for 1 year) Your company s logo featured on a professional sign displayed during lunch. Choice of the following Luncheon Break Prizes(prize will be awarded during lunch) [ ] Samsung Galaxy Tab A [ ] Canon SX530 PowerShot [ ] $250 Visa Gift Card [ ] Daily Exhibit Hall Break $1,500 Conference Attendee List ¼ Page Ad in Conference Brochure Special Bronze Sponsor Recognition (during conference, on conference brochures, & on AMBA s website for 1 year) Your company s logo featured on a professional sign displayed during breaks. Choice of the following Exhibit Hall Break Prizes (prize will be awarded during break) [ ] Samsung Galaxy Watch [ ] Lenovo Ideapad [ ] $250 Visa Gift Card

9 Application to Exhibit Continued [ ] Coffee Sponsor $1,500 Conference Attendee List ¼ Page Ad in Conference Brochure Special Bronze Sponsor Recognition (during conference, on conference brochures, & on AMBA s website for 1 year) Your company s logo featured on a professional sign displayed by the coffee cart. This sponsor would cover coffee beyond what is set out at breakfast. This sponsor can have branded cups made and set up at the coffee/beverage station for attendees. Standard Prize Sponsorship (Options vary select as many as you want below) These prizes will be used for the Medical Money Madness Auction and Standard Prize Giveaways. Your company will be recognized as the sponsor for the gift you choose. General session giveaway slots will be filled on a first come first served basis. [ ] $400 Beats Solo3 Wireless On-Ear Headphones Prize Sponsor Recognition (during conference, on conference brochures, & on AMBA s website) **Feature Product** [ ] $250 Fitbit Versa Prize Sponsor Recognition (during conference, on conference brochures, & on AMBA s website) **Feature Product** [ ] $150 Ring Wi-Fi Enabled Video Doorbell, Works with Alexa Prize Sponsor Recognition (during conference, on conference brochures, & on AMBA s website) **Feature Product** [ ] $150 Holy Stone HS200 FPV RC Drone with HD Wi-Fi Camera Live Feed Prize Sponsor Recognition (during conference, on conference brochures, & on AMBA s website) **Feature Product** [ ] $100 Hard Drive Backup 1TB Prize Sponsor Recognition (during conference, on conference brochures, & on AMBA s website) **Feature Product** [ ] $100 Roku Premiere+ Streaming Player Prize Sponsor Recognition (during conference, on conference brochures, & on AMBA s website) **Feature Product**

10 Application to Exhibit Continued [ ] I would like to donate my own prize instead (can be your product or services) Prize Sponsor Recognition (during conference, on conference brochures, & on AMBA s website) Prize Description: Prize Value: [ ] I m bringing it with me [ ] I m shipping to AMBA If shipping to AMBA, send to: American Medical Billing Association, 2465 E Main St, Davis OK Literature Sponsorship (prices vary select below) Perfect for companies that cannot attend or exhibit at the conference [ ] $750 Full Page Ad in Conference Brochure [ ] $900 Back Page Full Page Ad on Conference Brochure BROCHURE FRONT [ ] $500 Half Page Ad in Conference Brochure [ ] $200 Quarter Page Ad in Conference Brochure [ ] $400 Full Page Ad in Conference Attendee Registration Packet [ ] $200 Half Page Ad in Conference Attendee Registration Packet BROCHURE BACK For any sponsorship questions, please contact, Katie Taylor at katie@ambanet.net or call (580) Exhibitor & Sponsorship Tally Exhibitor Package Total: Gold Sponsorship Total: Silver Sponsorship Total: Bronze Sponsorship Total: Std. Prize Sponsorship Total: Literature Sponsorship Total: Total Amount Enclosed: Note to Sponsors: To maximize attendee numbers, AMBA highlights each sponsorship online, in printed material, and at the conference. This process is mutually beneficial for your company and AMBA. Therefore, sponsorship fees are non-refundable.

11 Application to Exhibit Continued Payment Information: [ ] Credit Card [ ] Check Make Checks Payable to: American Medical Billing Association, 2465 E Main St, Davis OK Credit Card #: Exp. Date CSV #: Cardholder Name: Cardholder Signature: Exhibitor Agrees to the following by signing below. American Medical Billing Association will not accept liability for damages of any nature sustained by Exhibitor/Sponsor or their accompanying persons, or the loss or damage of Exhibitor/Sponsor s property as a result of the 2019 AMBA National Conference or related events. Exhibitor/Sponsor agrees that they have read and understand all the information in the Invitation to Exhibit and 2019 Conference Application to Exhibit, and furthermore agrees that they will follow all the enclosed instructions. Release of Liability (initial each paragraph and sign below) Exhibitor hereby agrees to hold harmless AMERICAN MEDICAL BILLING ASSOCIATOIN INC (AMBA), Caesars Entertainment Corporation, and their subsidiaries, affiliates, owners, officers, shareholders, and personnel from any and all liability, costs, expenses, judgments, claims, etc. related to or in connection with the 2019 AMBA National Annual Conference event. Exhibitor acknowledges that AMERICAN MEDICAL BILLING ASSOCIATION INC nor Caesars Entertainment Corporation maintain insurance covering Exhibitor s property or personnel, and that Exhibitor must obtain insurance sufficient to cover any loss sustained by the Exhibitor, Exhibitor s property, or Exhibitor s personnel. Exhibitor hereby agrees to hold harmless of liability and waive any and all claims relating to AMERICAN MEDICAL BILLING ASSOCIATION INC if the event is canceled, delayed, relocated, reorganized, or any such action or event where Exhibitor is negatively impacted because of any action or act of God beyond AMERICAN MEDICAL BILLING ASSOCIATION INC s control. Exhibitor Representative Signature: Date: