Rural Health Education and Services

KU | Medical Center | Hospital

Date

October 18, 2007

The University of Kansas Medical Center
Kansas City, KS

October 25, 2007

School of Medicine-Wichita
Wichita, KS

I would like to register for both conferences.

INSTRUCTIONS: Please complete and submit by September 14, 2007 with your exhibit fee of Three Hundred Dollars ($300) for space for both events or Two Hundred Fifty Dollars ($250) for one event. Exhibit fee is waived for exhibitors who currently have a Contingency Contract with the Kansas Recruitment Center (not an Annual Contract). Please mail payment to The University of Kansas School of Medicine-Wichita, Rural Health Education and Services, 1010 N. Kansas, Suite 3026, Wichita, Kansas, 67214-3199. You will receive space confirmation on or before September 28, 2007. Please make checks payable to The University of Kansas Medical Center.

AGREEMENT: The undersigned hereby makes application for exhibitor space at the Kansas Career Opportunities event for 2007. The terms and conditions set forth in the Exhibit Information and Regulations, which is hereby made part of this agreement govern this agreement by reference. Acceptance of this application by KUMC constitutes a binding agreement between the KUMC and exhibitor.

Organization & Authorizing Individual

Organization:

Authorizing Name:

Title

Phone:

Primary Contact (will receive all future event information.)

**Please list information below as you would like it to appear in the program.**

Contact Name:

Address:

City/State/Zip:

Phone:

Fax:

Email:

Website:

Exhibit Representatives Names- Kansas City, Oct. 18th

(1):

(2):

(3) - @ $25.00:

(4) - @ $25.00:

(5) - @ $25.00:

Exhibit Representatives Names - Wichita, Oct. 25th

(1):

(2):

(3) - @ $25.00:

(4) - @ $25.00:

(5) - @ $25.00:

Registration Fee

Enter YES:

Registration fee has been mailed to 1010 N. Kansas, Suite 3026, Wichita, KS 67214. Please make checks payable to The University of Kansas Medical Center.

Regulations and Information

Enter YES:

Please click here to read our event Information and Regulations, and then enter "YES" in the box declaring you have reviewed them.