Today’s Date:

EXHIBIT BOOTH AGREEMENT

Third Theranostics World Congress on GA-68 and PRRT

Johns Hopkins Thomas B. Turner Building

March 12 - 14, 2105

80034404

COMPANY:	Company Name	CONTACT NAME:	Contact Name (Company)
ADDRESS:	Address
CITY:	City	STATE:	State	ZIP:	ZIP Code
PHONE:	Phone	FAX:	Fax
EMAIL:	Email Address	DISPLAY FEE:	Display Fee
NAME AND EMAIL OF REPRESENTATIVES TO BE PRESENT AT CONFERENCE:
REP 1:	Rep Name 1	REP 1 EMAIL:	Rep Email 1
REP 2:	Rep Name 2	REP 2 EMAIL:	Rep Email 2

Exhibitor representatives who would like to attend educational sessions are required to register separately for the conference.

Exhibit space includes: One 6'x30" table and 2 chairs will be provided.	# Outlets Needed: 1

Exhibits will be held at the Turner Concourse. Access to the exhibit area will be available for set-up on March 11, 2015 beginning at 12 noon. Registration will begin at 7:00 a.m. on March 12, 2015. Due to lack of storage space, please do not ship display to arrive prior to March 10, 2015. It is your company’s responsibility to make arrangements with a courier service to have the display picked up immediately following the last day of the activity.

Shipments should be addressed as follows:

Receiving Dock, Johns Hopkins University School of Medicine

1721 East Madison Street

Baltimore, MD 21205-2195

ATTN: Laura Friend

PLEASE HOLD FOR THE T3WC GA68 CONFERENCE, held March 12 - 14, 2015.

-------------------------------------------

I agree to abide by the ACCME Standards for Commercial Support:

Specifically 4.2 states: “Product-promotion material or product-specific advertisement of any type is prohibited in or during CME activities. The juxtaposition of editorial and advertising material on the same products or subjects must be avoided. Live (staffed exhibits, presentations) or enduring (printed or electronic advertisements) promotional activities must be kept separate from CME.” “For live, face-to-face CME, advertisements and promotional materials cannot be displayed or distributed in the educational space immediately before, during, or after a CME activity. Providers cannot allow representatives of Commercial Interests to engage in sales or promotional activities while in the space or place of the CME activity.” (Refer to ACCME standards at www.accme.org)

It is the Johns Hopkins Medicine policy that faculty and staff, employees, students, trainees, and volunteers may not accept gifts or entertainment, regardless of value, from pharmaceutical companies or medical device manufacturers or suppliers with respect to any activity at any JHM member organization site and any activity conducted under the auspices of or using the name of any JHM member organization. This policy extends to all exhibitors of this activity. To adhere to this policy no pens, pads, candy, etc. may be offered at your exhibit table.

By signing below the above company acknowledges and agrees to the following (1) The required exhibit fee is for the sole purchase of exhibit space and two complimentary registrations for exhibiting personnel. These personnel must complete and submit a registration form prior to the activity. (2) If more than two personnel wish to attend they must register separately and pay the full registration fee. (3) Payment is required by the company prior to the activity. (4) Each of the costs subsidized by the fee is incremental to the exhibit space and not standard institutional or organizational overhead, and (5) any payment to exhibit is not intended to influence planning of any CE/CME activity or interfere with presentations at any associated CE/CME activity.

PRINT OR TYPE NAME	AUTHORIZED SIGNATURE	DATE

CHECK MUST BE MADE PAYABLE TO HOPKINS/T3WC Ga68/80034404

Johns Hopkins University Federal Tax ID: 52 0595110

Kindly return this form with payment upon receipt to Laura Friend, Conference Coordinator, Johns Hopkins University, Office of Continuing Medical Education, Johns Hopkins University Central Lockbox, Bank of America, 12529 Collections Center Drive, Chicago, IL 60693.

Laura Friend PHONE: 410-614-0149	FAX: 443-224-9544	Email: lfriend1@jhmi.edu

Program information will be available at www.Hopkinscme.edu three months prior to activity.

INVOICE Invoice Number: 80034404 Date: 12/5/14	The Johns Hopkins University School of Medicine Office of Continuing Medical Education Turner 20, 720 Rutland Avenue Baltimore, MD 21205-2195 Phone: 410-614-0149 Fax: 443-224-9544

Third Theranostics World Congress on GA-68 and PRRT

80034404

Johns Hopkins Thomas B. Turner Building, Baltimore, MD

TO:	Company Name
FOR:	Exhibit Fee
AMOUNT:	$ Fee
DUE:	Payment is due 5 business days prior to start of activity.
The Johns Hopkins University Federal Tax ID: 52 0595110
NOTE: Activity budget number 80034404 on the check.
PAYMENT TYPE:
[ ]CHECK PAYABLE TO:	The Johns Hopkins University/80034404
[ ]Via WIRE TRANSFER TO JOHNS HOPKINS:
BANK NAME:	Bank of America
ACCOUNT NAME:	Johns Hopkins University Central Lockbox
ACCOUNT NUMBER:	003936830516
ABA NUMBER:	052001633
REFERENCE:	Continuing Medical Education; 80034404; Company Name
[ ]CREDIT CARD:	[ ]VISA [ ]MASTERCARD [ ]DISCOVER [ ]AMEX Card # Exp. Date Name on Card Signature and Date
MAIL TO:	Laura Friend, CME Conference Coordinator The Johns Hopkins University School of Medicine Office of Continuing Medical Education Johns Hopkins University Central Lockbox Bank of America 12529 Collections Center Drive Chicago, IL 60693