WCLC 2018 - Advisory Board & Ancillary Meetings

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

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 *

End Date *

Preferred Start Time

Preferred End Time

Expected Attendance

Location (Intercontinental Hotel, offsite, etc.)

Room Set-up *