Ph: 413-322-4242  Fax: 413-322-4259
Email: Joanna.barnett@bhs.org
www.baystatehealth.com/learn
Office of Continuing Education
361 Whitney Ave
Holyoke, MA 01040
EXHIBITS / DISPLAY
Baystate Health, Office of Continuing Education follows the ACCME, MARN/ANCC and APA standards for commercial
support and recognizes that accredited status refers only to its continuing education activities and does not imply ACCME,
ANCC/MARN or APA approval or endorsement of any commercial products.
By completing this form you agree to abide by these standards.
 When commercial exhibits are part of the overall program, arrangements for these will not influence planning or
interfere with the presentation of continuing education activities.
 Exhibit placement is not a condition of support for a continuing education activity.
 No commercial promotional materials shall be displayed or distributed in the same room immediately before, during,
or immediately after an educational activity certified for credit.
 Representatives of commercial supporters may attend an educational activity, but may not engage in sales activities
while in the room where the activity takes place.
COURSE TITLE:
DATE:
LOCATION:
Please indicate date(s) for exhibit
REPRESENTATIVE
Name:
Billing Address:
Phone Number:
Fax Number:
E-mail:
COMPANY
Name:
Billing Address:
Phone Number:
Fax Number:
E-mail:
I agree to pay the following exhibit/display fee:
Payment Method (please check one):
 CHECK
Please make check payable to:
Baystate Health Continuing Education
Tax ID Number: 04-2105941
All charge card payments are processed on our website:
https://academics.bhs.org/eventslms/getdemo.ei?id=2&s=_2F80OQ2FG.
Exhibits/Displays times are held during the registration period and refreshment breaks. We ask that you set-up ½ hour
before registration begins. For a schedule, please go to www.baystatehealth.com/learn and click on Course Brochures to
review the course brochure.
We supply:
* 1- 6 foot table
* Refreshment breaks (lunch is not included for companies paying display fee only)
* Registration is not included. You are invited to audit lectures on a space-available
basis.