CBAM Collaboration/Sponsorship Application (for one year) including CBAM Aesthetic Congress 2023 "*" indicates required fields Step 1 of 3 - Contact and Login Information 33% Step 1: Company/Organization InformationCompany/Organization Name* Company/Organization Website* Phone Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Company LogoAccepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 10 MB.Please upload a high quality logo of the company/organization.Company Primary Representative Contact InformationTitleDr.Mr.Mrs.Miss.Ms.Prof.Name* First Last Email* Phone*Terms and Conditions* I, on behalf of the company/organization mentioned above, acknowledge that I have read and agreed to the CBAM Sponsorship and Exhibition Terms of Agreement. CBAM Sponsorship and Exhibition Terms of Agreement Step 2A: Review Sponsorship Levels & Available SpotsStep 2B: Select the Sponsorship level and Your boothPlease select one of the sponsorship levels below:* Silver Sponsorship ($6,500+ HST) Gold Sponsorship ($1,2000+ HST) Please select a Silver booth:*S8S27The floor plan and booth numbers will be finalized by Jan 2023.Please select a Gold booth:*G11G12The floor plan and booth numbers will be finalized by Jan 2023. Step 3: PaymentPayment Details: Silver Sponsorship: $6,500 HST: $845 Total: $7,345 CAD Payment Details: Gold Sponsorship: $12,000 HST: $1,560 Total: $13,560 CAD Please select your method of payment:* Company or Personal Cheque Wire Transfer Please email us an online invoice Based on the agreement with CBAM The team will send you an online invoice and you are able to pay it with your Credit card.Please send a cheque to Canadian Board of Aesthetic Medicine with the exact amount to the following address: Unit 5F, 4773 Yonge St. North York ON M2N 0G2 We will send you the invoice and the receipt of your payment by email once we receive and process the full payment. Thank you. Wire Transfer Information We will send you the invoice and the receipt of your payment by email once we receive and process the full payment. Thank you. Please indicate the terms of agreement here:*CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
