Experiential Learning Exhibitor/Sponsor Form 2026

Activity #:

TBA

Event Title:

Synergy in Practice: Bridging Academia and Clinical Practice through Digital Innovation

Event Date:

June 18th, 2026

Event Location:

University of Rochester School of Nursing

Are you registering as an Exhibitor or a Sponsor?

Choose your registration type

I am registering as an exhibitor

I am registering as a sponsor

Please complete the form below to register as an exhibitor and confirm your understanding of the standards for commercial support of CNE.

Exhibitor Registration Information

Exhibiting Company

Name of First Company Representative Attending Summit

Email Address of Second Company Representative

Name of Second Company Representative Attending Summit (optional)

Email Address of Second Company Representative

Phone Number

Fax Number

Mailing Address

Country

Street

City

Region

Postal Code

Standards for Commercial Support of CNE

This continuing education activity is bound by Accreditation Council for Continuing Medical Education (ACCME) Standards for Integrity and Independence in Accredited Continuing Education.

Registration Confirmation

To confirm your registration, please agree to the following terms by checking each of the boxes and signing below.

I will participate in the University of Rochester Medical Center/Strong Memorial Hospital event.

I agree

I agree to pay the exhibit fee of $500. I understand that this fee includes a display table, and mention in program materials as an exhibiting company.

I agree

I agree to adhere to the Standards for Integrity and Independence in Accredited Continuing Education, Standard 5: Manage Ancillary Activities Offered in Conjunction with Accredited Continuing Education

I agree

I have read, understand and agree to abide by the University of Rochester Medical Center Policy on Industry Interactions.

I agree

I agree to hold the University of Rochester harmless from any liability, damages, or costs (including reasonable attorneys' fees) that may arise because of exhibiting at this CE conference. Without limiting the breadth of this hold harmless agreement, I acknowledge that it shall extend to include the loss, damage, or theft of any equipment or materials brought to the conference site as well as injuries that any of my employees or agents may incur.

I agree

If the event is occurring on university premises, per university policy, exhibitors must provide a Certificate of Insurance. This is a requirement for all conferences held at the University of Rochester to be able to exhibit at that conference. I agree to meet the insurance requirement by providing School of Nursing with proof of insurance for my company.

I agree

Company Representative Signature: By typing your name below, you acknowledge and agree to the terms & conditions above.

Please type your signature:

Sponsorship Agreement

Sponsorship is financial or in-kind contributions from an organization that does not fit the category of a commercial interest and that are used to pay for all or part of the costs of a CNE activity.

A commercial interest as defined by the American Nurse’s Credentialing Center (ANCC), is any entity producing, marketing, reselling, or distributing healthcare goods, or services consumed by or used on patients, or an entity that is owned or controlled by an entity that produces, markets, resells, or distributes healthcare goods or services consumed by or used on patients. Nonprofit or government organizations, non-healthcare-related companies, and healthcare facilities are not considered commercial interests.

NOTE: Organizations providing commercial support may not provide or co-provide an educational activity.

Name of Accredited Provider: The University of Rochester Center for Nursing Professional Development

Organization Providing Sponsorship:

Total Amount of Sponsorship:

Area of Activity Organization Providing Sponsorship Would Like To Support:

Please specify

* The organization providing sponsorship may request that funds be used to support a specific part of an educational activity. The Accredited Provider may choose to accept the restriction or not accept the sponsorship. The Accredited Provider maintains responsibility for all decisions related to the activity as described below

Please upload a copy of your logo in .pdf or Word format.

Terms and Conditions

This activity is for educational purposes only and will not promote any proprietary interest of an organization providing sponsorship.

The Accredited Provider is responsible for all decisions related to the educational activity. The organization providing sponsorship may not participate in any component of the planning process of an educational activity, including:

Assessment of learning needs
Determination of objectives
Selection or development of content
Selection of planners, presenters, faculty, authors and/or content reviewers
Selection of teaching/learning strategies
Evaluation methods

The Accredited Provider will make all decisions regarding the disposition and disbursement of sponsorship in accordance with ANCC criteria.

All sponsorship associated with this activity will be given with the full knowledge and approval of the Accredited Provider. No other payments shall be given to any individuals involved with the supported educational activity.

Sponsorship will be disclosed to the participants of the educational activity.

The organization providing sponsorship may not exhibit, promote or sell products or services during the introduction of an educational activity, while the educational activity takes place or at the conclusion of an educational activity, regardless of the format of the educational activity.

Organization Providing Sponsorship Information

Name of Orgranization

Name of Representative

Email Address

Phone Number

Fax Number

Mailing Address

Country

Street

City

Region

Postal Code

Statement of Understanding

An “X” in the box below serves as the electronic signatures of the representatives duly authorized to enter into agreements on behalf of the organizations listed and indicates agreement of the terms and conditions listed in this Sponsorship Agreement.

Electronic Signature

Please type your signature:

Date

Completed By (Name & Credentials)

Select Payment Method

Credit Card (preferred)

Check

In-Kind Donation

Thank you for your In-Kind Donation. Please enter the type of in kind donation you wish to make below We will contact you to finalize the details.

Make Checks Payable to:

University of Rochester School of Nursing
Memo: Experiential Learning Summit
The Institution Tax ID # is 16-0743209

Mail to:
Elizabeth Mournighan
University of Rochester
School of Nursing
601 Elmwood Avenue
Box SON
Rochester NY, 14642

Payment

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