ASCRS Affiliate Function Request Form

ASCRS & ASOA Annual Meeting Affiliate/ICW Event Function Application

All meetings and events hosted by industry, attendees, or non-attendees must be submitted to ASCRS through the online space application process and must be approved by ASCRS. Affiliate functions are defined as meetings, events, dinners, a private room, and any off-site function that requires its own space outside of your exhibit booth and outside of the convention center. Please note that you must submit one application per event, per day. Payment is collected after completion of the application.
Company Name*
Event/Function Title*
Event Date*
Event Time*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Please ensure your event does not occur during blackout hours listed in the policies and procedures PDF. If your event falls in between blackout hours, your application will be declined.
Will you require AudioVisual (A/V)?*

YesNo
Will you require Food & Beverage (F&B)?*

YesNo
If Yes to F&B, Please Select the Type
Event Type*
If "Other" Event Type:
Room Set*
Type of Audience*
Estimated Number of Attendees*
Physicians Attending*
1st Preferred Hotel Location*
2nd Preferred Hotel Location*
3rd Preferred Hotel Location*
If "Other" location:
Special Requests

Third-Party Contact Information*

*Please only submit if applicable. If you do not have a Third-Party Vendor, please select "Next" below.
Main Contact Name

First NameLast Name
Third-Party Company Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Company Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Application Fee*

Exhibitor - Non-Refundable Administrative FeeApplications submitted between January 1 - April 10tht: $650

$650.00 Quantity

Non-Exhibitor - Non-Refundable Administrative FeeApplications submitted between January 1 - April 10: $5,000

$5,000.00

Total

$0.00

Main Contact Information