2026 Nebraska Chapter Industry Support Application

2026 Nebraska Chapter Industry Support Application

Deadline: Friday, March 27, 2026
Complete the fields below, enter payment and sign.The information provided will be displayed onsite and on the Nebraska Chapter website.

If you have questions, contact DéJah Jones at djones@acschapters.org or 312.448.7668.
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name*

First NameLast Name
Contact Email*
example@example.com
Contact Phone Number*
Please enter a valid phone number.
Payment can be made via credit card or check. Please notify DéJah Jones if you are planning on paying by check.
Credit Card - Online application includes credit card payment.
Check Payment - Make check payable to:
Nebraska Chapter of ACS
7780 Elmwood Ave, Suite 130
Middleton, WI 53562
Payment Type*

CheckCredit Card
Products*

Booth Fee $1,500

My Products*

Booth Fee6’ table and (2) chairs, (1) Exhibitor Registration, Company name and logo added to PowerPoint slide during breaks, Company name, logo, description, and hyperlink on website

$1,500.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Nebraska Chapter 2026 Annual Meeting Agreement

By clicking below, you understand and agree to comply with all policies, rules, regulations, terms and conditions contained in the Exhibitor Prospectus; will abide by the payment policy; have read the rules and regulations; and for proper executive, agree to distribute them to those individuals involved with your booth.

If you have questions, contact DéJah Jones at djones@acschapters.org or 312.448.7668.
I agree to the rules and regulations stated on the ACS Cancer Exhibitor Information website page.
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