NapraFusion Exhibitor Registration Form

Join us at NapraFusion, the premier event for healthcare professionals and naprapathic care enthusiasts, hosted by NCNMU Health at Insight Hospital & Medical Center. This dynamic health fair is the place to be for those passionate about naprapathic care, as well as those seeking to integrate it into their practice. Be part of a diverse community dedicated to redefining wellness and advancing holistic health practices. We are thrilled about our growing relationship with Insight Hospital, which promises exciting developments with NCNM University & NCNMU Health in the near future.

GENERAL BUSINESS INFORMATION

Name of Entity, Individual(s), Partners or Corporation

Doing Business As (Write "SAME" if same as above) / Type of Business

COMPANY BUSINESS ADDRESS

Enter the physical address for the main office.

Address Line 1

Address Line 2

City

State

Zip Code

Street Address (P.O. Box is not permitted)

CONTACT PERSON:

Enter your firm’s contact person’s name and title.

First

Last

Enter your firm’s contact person’s title.

COMPANY’S / FIRM’S TELEPHONE NUMBERS AND EMAIL ADDRESS

Contact's Email Address

Contact's Phone

AFFIRMATIONS AND SIGNATURES

The undersigned hereby certifies that the foregoing statements are true and correct and included all of the material necessary to identify and explain the operation of the business described herein. The undersigned agrees to provide NCNMU Health with current, complete and accurate information for each project contracted and for all proposed changes in any contractual agreement. Misrepresentations shall be grounds for terminating any contract.

Please make your selection for participation

Saturday, November 16, 2024 – $154.50

There is a 3% Convenience fee for credit card processing.

Total

$0.00

Signature

Clear Signature

Date

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