Nautical Night Ticket & Ad Form

Name

Name(Required)

First Last

Email

Email(Required)

Phone

Phone

Billing Address

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Membership Status

Current PAMS Member?

Yes

Junior PAMS Member?

Yes

Interested in joining Junior PAMS?

Yes

Maybe

Tickets

We offer early bird ticket pricing through April 15th: $200 for adults and $125 for juniors. After April 15th, ticket prices will increase to: $250 for adults and $150 for juniors.

I am purchasing as a:(Required)

Adult

Junior

Advertiser or Donor only (no tickets)

Juniors include: high school or undergraduate students, any advanced trainees such as medical students, or PhD students, etc., as well as residents and fellows.

Adults:

Juniors (40 ticket limit):

Current Status (to be completed for Junior registrations only):

Current Status(Required)

High School Student

Undergraduate Student

Healthcare Student

Medical Student

PhD Student

Resident

Fellow

Other

Institution(Required)

Specialty (or intended specialty, if applicable)

Years in Current Role(Required)

List of Guests

ATTENTION institutional purchasers: If you do not know all the names of the attendees from your institution yet, please populate your own name to the unknown name fields. Please contact us at pams@zlpchicago.org once the missing names are available.

Name(Required)

First Last

Name(Required)

First Last

Name(Required)

First Last

Name(Required)

First Last

SEATING PREFERENCES

(Please, list the guests you wish were seated at your table)

Advertisements

Advertising

Advertising Rates
The Abstract and Program Advertisements Can Help Your Business. Please be sure to include clean artwork when possible. If you don’t have artwork, write down your greeting card and attach a business card. We will do the ad for you. Camera ready art also can be emailed in PDF or TIF format once payment has been arranged. We can also use your ads from previous PAMS campaigns that you have generously supported.

Advertising Rates:

Full Page 7.25(w) x 9.7(h) & Social Media Blast

Full Page 7.25(w) x 9.7(h)

Half Page 7.25(w) x 4.75(h)

Upload Advertisement Media

Add file

Drop files here or

Max. file size: 512 MB.

Name of the Company or Business To Be Advertised

Business Name To Be Advertised:

The deadline for advertisement submissions is June 1st 2026

Donations

Make a Donation
Please Enter Value in Whole Dollars

Donation Amount:

Payment Options:(Required)

ATTENTION attendees from outside of the US: if you have issues paying by credit card directly, please click “Want to pay online,” then select PayPal Checkout as a card Payment Method below, (no PayPal Account is necessary for most countries, just deselect the”create your PayPal account” button when navigating through prompts.) No international checks will be accepted.

Want to pay online

Please mail your checks to: Polish American Medical Society, 1450 W Lake Street, Suite 101, Addison , IL 60101

Please send your Zelle payment to: pams@zlpchicago.org

Online Payment Processing Fee

Price: $0.00

Total

Payment Method:

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Communication Consent – I consent to receive updates about future PAMS events and opportunities:(Required)

Yes

Media Consent – By purchasing a ticket and attending this event, you consent to photography and video recording. These materials may be used for PAMS marketing, promotional, and educational purposes.(Required)

Yes

Notice – This is a private event hosted at a private club. We reserve the right to refuse entry or remove any attendee for inappropriate or disorderly conduct, or for any behavior inconsistent with the standards of the hosting organizations or venue. Ticket purchases may be canceled at our discretion, with a full refund issued where applicable.

Nautical Night 2026