Exhibit Application - 18th Annual Academic Surgical Congress

Company Name:*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
PRE-SHOW CONTACT INFORMATION
Name*
First Last
Title
Phone*
Email*
INTERACTIVE MODULE
ASC strongly encourages exhibiting companies to include an interactive component in their booths. The interactive component may be a hands-on skills module, game or quiz which will challenge attendees to successfully complete a specific task within a given time frame. The tasks can range from knot tying, to suturing, to simulated skills or games, each of which tests aspect of surgical ability or knowledge.*
ASC strongly encourages exhibiting companies to include an interactive component in their booths. The interactive component may be a hands-on skills module, game or quiz which will challenge attendees to successfully complete a specific task within a given time frame. The tasks can range from knot tying, to suturing, to simulated skills or games, each of which tests aspect of surgical ability or knowledge.
- We will be participating with an interactive module
- We will NOT be participating with an interactive module
Please describe your interactive module:*
Exhibit Reservation and Payment
Early bird fee (prior to November 19, 2021)- 6' Tabletop: $2,000

Standard fee (on or after November 19, 2021)- 6' tabletop: $2,300
Payment Method*
- Credit Card - Full Payment
- Credit Card - 50% Payment
- Check - Please send invoice
- Check - 50% Payment, Please send invoice
Please make check payable to the Academic Surgical Congress and send to:
Academic Surgical Congress
11300 W. Olympic Blvd. Suite 600
Los Angeles, CA 90064
Note- a $500 fee per exhibit reservation will be assessed on all cancellations received on or before January 7, 2022. No refunds will be processed after January 7, 2022.
Booths
Price:
Booths
Price:
Hidden
When should we expect to receive your payment:*
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
I do not wish my booth to be adjacent to (list no more than 3 companies):
Booths will be assigned at the sole discretion of show management and will be based on the date of request, requested locations, and consideration of competition. Payments must be made in full to secure your booth location. No specific booth guarantees will be made until payment is received.
Exhibitor Agreement*
- I certify that I have read the Exhibitor Prospectus which outlines the rules and regulations which are part of this contract. I further certify that all company staff participating in the ASC meeting will abide by the rules and regulations as set forth by the ASC. The ASC will provide industry the opportunity to exhibit and interface with meeting attendees. Exhibit hours, booth location and food and beverage events will be leveraged to encourage registrants to visit exhibit booths

PRE-SHOW CONTACT INFORMATION

INTERACTIVE MODULE

Exhibit Reservation and Payment

Note- a $500 fee per exhibit reservation will be assessed on all cancellations received on or before January 7, 2022. No refunds will be processed after January 7, 2022.

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