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Agency (If applicable):
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Please check all that apply. Incomplete orders will experience delay in processing.
*An edited sample piece must accompany all orders. YDC reserves the right not to fulfill your request based upon the content of your mailing. Items included in lists are name, designation, company, and address. All orders are sent via e-mail in excel format, unless otherwise indicated. Allow 14 days for order to be processed. The lists are pulled weekly (Monday) beginning 11/29/2010.
Please indicate the date you prefer your list to be sent
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| Credit Card Payment: |
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Expiration Date:
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Name on Card:
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Authorized Signature:
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Term & Conditions of List Rental
List renter agrees to not resell, disclose, transfer, duplicate, reproduce or replicate any part of the list. List is limited to a one time usage solely to market or promote the above named exhibitor. List renter is permitted to use the list in merge/purge only for the purpose of eliminating duplicate names. In the event the list renter uses the list contrary to this agreement, the list renter will be held unconditionally responsible. Therefore, any and all costs incurred by Yankee Dental Congress in enforcing this agreement will be the responsibility of the list renter. There are no refunds for the renting of the list. It is clearly understood that Yankee Dental Congress in no way endorses any product or service or the above-mentioned exhibitor by renting the list. List renter agrees to indemnify and hold harmless Yankee Dental Congress from any and all claims, damages, losses or expenses, however incurred, occasioned by the use of the list. This agreement covers a 12 month period. It is understood that list orders are seeded with decoy names to monitor unauthorized use and use is tracked. Reuse of list will be invoiced. By signing this contract, you agree to the Terms and Conditions of the List Rental. (Signature required for processing)
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| Print Name: |
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| Authorized Signature: |
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