Event Request

ASCRS Annual Scientific Ancillary Event Request

All information is required. Incomplete request forms will not be considered.

Function Type (select one):	Alumni/Healthcare Affiliate Industry/Sponsor
Name of Facility/Organization/Company:
Contact Name:
U.S. Phone Number:	( ) - Second three digits Last four digits Enter area code on first line, next three digits on second line and four digits on last line
Email:
Requested Date:
Requested Time:
Number of Attendees:
Requested Location:	Convention Center Headquarters Hotel (Sheraton)
Requested Setup:
50-word Description of the Requested Event:
Would you like to learn more about promotional support of your event? :	Yes (additional fees apply) No
Requested Posting on our website/mobile app:	Yes No

Fees:

Alumni/Affiliates:

If the request is accepted, a fee will be charged. You will be invoiced and payment in full is required before final approval is granted.

A member of the ASCRS Corporate Relations team will contact you to discuss specifics.