INTERNATIONAL MEDICAL CONFERENCE
THE INTERNATIONAL ASSOCIATION OF HEALTH CARE PROFESSIONALS
EXHIBITION APPLICATION FORM
Maintaining Challenges in Medical Practice, Family Medicine and Education
London, UK
21 - 24 August 2010
1. NAME OF ORGANISATION:
2. REPRESENTATIVE(S):
Miss
Ms
Mr
Mrs
Dr
Prof.
Miss
Ms
Mr
Mrs
Dr
Prof.
Miss
Ms
Mr
Mrs
Dr
Prof.
Miss
Ms
Mr
Mrs
Dr
Prof.
FIRST NAME:
a)
b)
c)
d)
SURNAME:
a)
b)
c)
d)
3. ADDRESS OF ORGANISATION:
POST CODE:
EMAIL:
TEL:
FAX:
MOBILE PHONE:
4. NATURE OF BUSINESS:
5. DO YOU REQUIRE CAR PARKING SPACE?
Yes
No
IF YES, PLEASE STATE NUMBER OF CARS:
ARE YOU COMING WITH YOUR TABLE/STAND?
Yes
No
IF YES, GO TO NO. 6
6. HOW MANY TABLE/STAND DO YOU NEED? PLEASE SPECIFY SIZE AND QUANTITY
7. REQUIREMENT FOR DISPLAYING PRODUCTS:
Projection requirements for presentation if accepted:
OHP
Video
CD
DVD
Data projector
Bringing own laptop
Required laptop
Slide projector (PowerPoint Slides)
Internet connection
8. TITLE OF ABSTRACT:
9. ABSTRACT:
I / We release copyright of this abstract with consent and authority to the organisers of this conference for the abstract to be published in the Book of Proceedings and deposited in the United Kingdom Legal Deposit Box for safe keeping and future reference. (Please note the presenting author or the researcher must sign number 14 and 15 below to enable the abstract to be published in the Book of Proceedings).