ASCRS/ASOA 2026 ICW/Affiliate Function Request Form

ICW/Affiliate Meeting Space Function Request Form

All meetings and events hosted by industry representatives, attendees, or non-attendees must be submitted to ASCRS/ASOA through the online space application process and approved by ASCRS/ASOA. Affiliate functions are defined as any meetings, events, dinners, private room bookings, or off-site functions that require space outside of your exhibit booth and outside of the convention center. Please note that a separate application must be submitted for each event, per day. Payment will be collected upon 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
Affiliate Function Event Hours

Affiliate meetings and functions may be held within the following time periods: Thursday, April 9: No restrictions, affiliate functions can be held at any time. | Friday, April 10*: Prior to 8:00 a.m. & after 5:30 p.m. | Saturday, April 11: Prior to 8:00 a.m. & after 5:30 p.m. | Sunday, April 12**: Prior to 8:00 a.m. & after 5:30 p.m. | Monday, April 13: Prior to 8:00 a.m. & after 5:30 p.m. | *The ASCRS Foundation Party for a Purpose takes place on Friday, April 10 from 8:00–11:00 p.m. | **The ASCRS Annual Film Festival Reception and Ceremony is on Sunday, April 12 from 5:15–7:00 p.m.
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

Main Contact Information
Main Contact Name*

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

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Will you be utilizing a Third-Party to plan this function?*

Third-Party Contact Information*

*If you will be utilizing a Third-Party to assist with the planning of this ICW/Affiliate Function, please share their contact information 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 Fee

September 1–December 31: $500. January 1–March 27: $650.

$650.00 Quantity

Non-Exhibitor - Non-Refundable Administrative Fee

September 9–December 31: $4,000. January 1–April 10: $5,000. On/after April 11: $6,000.

$5,000.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

ICW/Affiliate Meeting Space Function Request Form

Affiliate Function Event Hours

Main Contact Information

Third-Party Contact Information*