ANCILLARY EVENT REQUEST FORM
Please complete all sections of the following Ancillary Event Request Form.
If you require multiple events, please complete one form for each function you would like to hold.
1) Contact Information
*
Company Name
Third Party Organizer (i.e. Medical Communication Firm)
Contact Person
Address
City/State
Postal Code
Country
Phone Number
Email
2) Event Information
Type of Meeting
*
Advisory Board Meeting (incl. Health Care Professionals) - USD 10,000
Office/Meeting Space (excl. Health Care Professionals) - USD 3,500/Day
Time & Date of Meeting
*
Meeting Title
Start Date
*
Saturday, September 22
Sunday, September 23
Monday, September 24
Tuesday, September 25
Wednesday, September 26
Thursday, September 27
End Date
*
Sunday, September 23
Monday, September 24
Tuesday, September 25
Wednesday, September 26
*
Preferred Start Time
Preferred End Time
Expected Attendance
Location (Intercontinental Hotel, offsite, etc.)
Room Set-up
*
Boardroom
U-shape
Hollow square
Round tables