Baystate Continuing Interprofessional Education ACNM Region 1 Conference: Strengthening Midwifery Through Advocacy,Leadership, and Knowledge September 20-21, 2024 Baystate Health Education Center, 361 Whitney Avenue, Holyoke MA, 01040 Agreement between Baystate Continuing Interprofessional Education - BCIPE and: Company Name (Exhibitor) * As it should appear on printed materials Address (Street, City, State, Zip Code) * Name(s) of Representative(s) Exhibiting * Representative Exhibiting Phone * Representative Exhibiting Email * Contact Name / Email / Phone (if different than the Representative Exhibiting) Terms and Conditions Baystate Health Continuing Interprofessional Education follows the ACCME Standards for Integrity and Independence in Accredited Continuing Education.EXHIBITOR agrees to abide by ACCME accreditation requirements and ACCME Standards for Integrity and Independence in Accredited Continuing Education (“Standards”) as stated at https://www.accme.org/publications/standards-for-integrity-and-independence-accredited-continuing-education. The Standards include, but are not limited to, the following requirements:Accredited continuing education must protect learners from commercial bias and marketing.Accredited education must be free of marketing or sales of products or services. Faculty must not actively promote or sell products or services that serve their professional or financial interests during accredited education.The accredited provider must not share the names or contact information of learners with any ineligible company or its agents without the explicit consent of the individual learner.EXHIBITOR may only distribute educational promotional materials at their exhibit space. Distribution of non-educational items (pens, notepads, etc.), pharmaceuticals or product samples is prohibited.Representatives of commercial supporters may attend an educational activity, but may not engage in sales activities while in the room where the activity takes place.All exhibit fees associated with this activity will be given with the full knowledge of the ACCREDITED PROVIDER. No additional payments, goods, services or events will be provided to the course director(s), planning committee members, faculty, joint provider, or any other party involved with the activity.Completion of this agreement represents a commitment and EXHIBITOR is obligated to provide full payment of all amounts due under this agreement by the ACTIVITY DATE unless otherwise agreed upon by the ACCREDITED PROVIDER. ACCREDITED PROVIDER reserves the right to refuse exhibit space to EXHIBITOR in the event of nonpayment or Code of Conduct violation.ACCREDITED PROVIDER agrees to provide exhibit space and may acknowledge EXHIBITOR in activity announcements. ACCREDITED PROVIDER reserves the right to assign exhibit space or relocate exhibits at its discretion.When commercial exhibits are part of the overall program, arrangements for these will not influence planning or interfere with the presentation of continuing education activities.Note: All exhibitors must be approved by BCIPE and this agreement is not binding until both parties have signed. BCIPE maintains the right to refuse any exhibitor. PaymentBaystate Health ACCREDITED PROVIDER Federal Tax ID number is 04-2105941 Form of Payment * Indicate your form of Payment Credit Card Payment - Preferred Check Payment - Baystate Continuing Interprofessional Education, 3601 Main Street, 3rd Floor, Springfield, MA 01199 | REF: ACNM Region 1 Conference *NOTE* This completed form must be printed out and sent with your check payable to Baystate Continuing Interprofessional Education ACH Contact Marion Talbot (413-794-9783) to process credit card payment. Is payment processed through a third party? * Yes No Company name (and contact info if available) from third party payer: Please DO NOT enter payment information here. Refer to exhibit request packet. We will be exhibiting: * Virtually $x,xxx (add fee or delete if not appliable) Exhibit Table $x,xxx (add fee or delete if not appliable) Exhibit Table and Workshop $x,xxx (add fee or delete if not appliable) Unfortunately, we will not be able to exhibit, but would like to support your program. Company / Division Logo PLEASE SUBMIT LOGO WITH TRANSPARENT BACKGROUNDFiles must be less than 2 MB.Allowed file types: gif jpg jpeg png. Representative 1 Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Product Information You may enter links to product pages here SignaturesThe person signing below is authorized to enter into this agreement. By signing below, I agree to the "Terms and Conditions" outlined in this Exhibitor Agreement (including ACCME Standards for Commercial Support) and to pay the selected exhibit/display fee: Exhibitor Representative Signature * Leave this field blank