BIAA-ME 2023 Conference Primary Sponsor/Exhibitor Personnel Registration

Complimentary registration for sponsor and exhibitor staff at the 14th annual conference, "Defining Moments in Brain Injury," presented by the Brain Injury Association of America – Maine Chapter (BIAA-Maine).

First Name of Sponsor/Exhibit Personel*

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Last Name of Sponsor/Exhibit Personnel*

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Title of Sponsor/Exhibit Personnel*

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Organization Name*

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E-mail of Sponsor/Exhibit Personnel*

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Phone of Sponsor/Exhibit Personnel*

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Address Type*

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Street Address*

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City*

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State*

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Zip*

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ADA Accommodations Request (Optional)

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If you have a disability covered by the Americans with Disabilities Act (ADA) and would like to request an accommodation, please specify the request here.

Special Dietary Needs (allergy, gluten free, etc.)

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Complimentary staff registration(s) included with Sponsorship/Exhibit for the 14th annual conference, "Defining Moments in Brain Injury," presented by BIAA-Maine.

When: September 27, 2023 (for preconference sponsor) and September 28, 2023 (for conference sponsors and exhibitors)

Where: Holiday Inn by the Bay – Portland, Maine

ADA Accommodation Request: If you have a disability covered by the Americans with Disabilities Act and would like to request an accommodation, please indicate it in the space provided.