Home > form-test

form-test

71st Physicians Ball

Ticket and Advertisement Form

Name

Name(Required)

First Last

Email

Email(Required)

Phone

Phone

Address

Address(Required)

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

Guests

Price: $450.00

Purchase 10 (table) or more tickets, receive 10% discount!

Students/Residents

STUDENTS/RESIDENTS Discount $250/ticket

Price: $250.00

(The discount applies ONLY to students and residents. If accompanied by another person who is not a student or resident, please pay the full price of $450.00)

List of Guests

Name	chosen dinner	Actions

There are no attendees.

SEATING PREFERENCES

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

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

First Back Cover 7.25(w) x 9.7(h)

Inner Cover Page 7.25(w) x 9.7(h)

Full Page 7.25(w) x 9.7(h)

Half Page 7.25(w) x 4.75(h)

1/4 Page 3.5(w) x 4.75(h)

Upload Advertisement Media

Add file

Drop files here or

Max. file size: 100 MB.

The deadline for advertisement submissions is September 5, 2025.

Make a Donation
Please Enter Value in Whole Dollars

Donation Amount

Name of the Company or Business To Be Advertised

Business Name To Be Advertised

PayPal Fee

Price: $0.00

Total

Payment Method

Payment Options(Required)

Want to pay online

Want to send a check