VaSAM 2024 Sponsor/Exhibitor Interest Form

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Thank you for your interest in the Virginia Society of Addiction Medicine 2024 Annual Conference (VASAM 2024). VaSAM 2024 will take place November 1-2, 2024 at the Westin Dulles in Herndon, VA. Please fill out the form and a member of our Staff will reach out with more details on securing your Sponsorship/Exhibitor Table. Thank you in advance for your support!!

Email *

First Name: *

Last Name: *

Suffix (i.e. MD, PhD, etc.) *

Company/Organization: *

Position/Title: *

Which Sponsorship Level are you interested in? *

Flagship Sponsor ($4.750)

Event Sponsor ($2,700)

Exhibitor ($1,500)

What is your preferred payment method? *

Pay via credit card: VaSAM Staff will email you a secure link for your payment (note: a 3.5% processing fee will apply)

Mail a check within 2 weeks: VASAM, PO Box 699, Mechanicsville, VA 23111

Your Full Mailing Address (for invoice): *

Your Telephone Number: *

If you have any questions for the VaSAM Staff please let us know!

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