Common use of Payment and Cancellation Policy Clause in Contracts

Payment and Cancellation Policy. All sponsor/exhibitor payments are required within thirty days after the receipt of their reservation form. All payments must be made prior to the beginning of the event. Cancellations received 30 days prior to the event will be assessed a 25% cancellation fee. Cancellations received between 30 and 10 days prior to the event will be assessed a 50% cancellation fee. If the cancellation is received less than 10 days prior to the event a 100% cancellation fee will be assessed and no payment will be refunded. Referral-for-Profit Agreement MPTA will not process an order unless the purchaser has read the provisions below and has agreed to all terms, has indicated agreement by checking the “I agree” box, and has signed and dated and submitted this agreement along with the order form. Michigan Physical Therapy Association (MPTA) follows the American Physical Therapy Association (APTA) position on potential referral for profit. APTA is opposed, as a matter of health care policy, to arrangements under which sources of referral (including physicians) stand to profit from referring patients for physical therapy. The policy adopted by the House of Delegates, Financial Considerations in Practice (HOD 00-00-00-00) states: “The American Physical Therapy Association opposes participation in services that is in any way linked to the financial gain of the referral source.” Because of this policy, MPTA does not accept advertising orders from an organization or individual in a practice if any physician has a financial interest in the practice and refers patients to an employed physical therapist or to a physical therapist who supervises an employed physical therapist assistant. To complete your submission to MPTA, you must make the following certification by checking the “I agree” box below: “I certify that no referral source (including any referring physician) has a financial interest in the practice that has the position that is the subject of this sponsorship/exhibit.” Please note that if you agree to this statement, you may be asked to provide conclusive documentation as to the ownership of the facility, the identity of its employees, and the referral patterns of such owners and/or employees. If MPTA in the future discovers that any referral source has a financial interest in your facility (as owner and/or employee), any orders or agreements with MPTA will be cancelled immediately, with no refund of payment. I agree. Name (print): Title: Signature: Date: Sponsor/Exhibitor Contact Information Company Contact Name Title Street Address City, State, Zip Phone # Email Signature Payment Method

Payment and Cancellation Policy. All sponsor/exhibitor payments are required within thirty days after the receipt of their reservation form. All payments must be made prior to the beginning of the event. Cancellations received 30 days prior to the event will be assessed a 25% cancellation fee. Cancellations received between 30 and 10 days prior to the event will be assessed a 50% cancellation fee. If the cancellation is received less than 10 days prior to the event a 100% cancellation fee will be assessed and no payment will be refunded. Referral-for-Profit Agreement MPTA will not process an order unless the purchaser has read the provisions below and has agreed to all terms, has indicated agreement by checking the “I agree” box, and has signed and dated and submitted this agreement along with the order form. Michigan Physical Therapy Association (MPTA) follows the American Physical Therapy Association (APTA) position on potential referral for profit. APTA is opposed, as a matter of health care policy, to arrangements under which sources of referral (including physicians) stand to profit from referring patients for physical therapy. The policy adopted by the House of Delegates, Financial Considerations in Practice (HOD 00-00-00-00) states: “The American Physical Therapy Association opposes participation in services that is in any way linked to the financial gain of the referral source.” Because of this policy, MPTA does not accept advertising orders from an organization or individual in a practice if any physician has a financial interest in the practice and refers patients to an employed physical therapist or to a physical therapist who supervises an employed physical therapist assistant. To complete your submission to MPTA, you must make the following certification by checking the “I agree” box below: “I certify that no referral source (including any referring physician) has a financial interest in the practice that has the position that is the subject of this sponsorship/exhibit.” Please note that if you agree to this statement, you may be asked to provide conclusive documentation as to the ownership of the facility, the identity of its employees, and the referral patterns of such owners and/or employees. If MPTA in the future discovers that any referral source has a financial interest in your facility (as owner and/or employee), any orders or agreements with MPTA will be cancelled immediately, with no refund of payment. I agree. Name (print): Title: Signature: Date: Sponsor/Exhibitor Contact Information Company Contact Name Title Street Address City, State, Zip Phone # Email Signature Payment MethodMethod Please Invoice Check Enclosed Check Following in Mail Credit Card Credit Card Payment NOTE: Do not include credit card information on forms that are sent to MPTA via email. Please mail or call 000-000-0000. Card Type Visa MasterCard AmEx Credit Card Billing Address: Cardholder Name Street Credit Card # Expiration Date CVV Code City, State, Zip