Exhibitor/Sponsor Brochure and the Registration

Mark your calendars for Friday, April 26, 2019 from 9 am – 12:30 pm at the

Brevard County Health Department
2555 Judge Fran Jamieson Way, Viera, FL 32940
Posey Conference Center –in rear of building

Exhibitor Space is $150. You may register online by filling out the form below.

_____________________________

Click Here to Download DGF W9
The Doctors Goodwill Foundation’s Tax ID# 200716768

Registration For Exhibitors and Sponsors

Name*
First Last
Name*
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name of DGF Rep
Sponsor Category*
Sponsor Amount*
Payment Method:
- Check sent
- Pay by credit card
Please be sure the URL bar has https:// before our domain to ensure you are entering your credit card information on a secure site.
This page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes.
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Payments – Please make checks payable to

Doctors’ Goodwill Foundation

Tax ID# 200716768

Mail to:

P.O. Box 909

Titusville, FL 32781

Exhibitor/Sponsor Brochure and the Registration

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