So. Texas Exhibitor Application Form

Exhibitor Application Form

2022 South Texas Chapter ACS Annual Meeting
Company Information

Please list exactly as you would like it to appear on the recognition signage and name badges
Company Name *
Main Contact Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Exhibitor & Event Sponsors
Check all that apply

Exhibitor Level - $2,000 Electricity Fee - $75.00 Additional Rep. - $150
Event Sponsors

William J. Pokorny, MD Named Lecture - $1,000 Stump the Attendees - $1,000 Great Debates - $1,000 Networking Break - $1,250 (3 available) Continental Breakfast - $1,500 (2 available) Poster Session - $1,500 (3 available) Resident & Governor’s Breakfast - $2,500 Attendee Lunch - $2,500 Meeting App + WiFi - $2,000 Women in Surgery Luncheon - $3,000 Resident Surgical Jeopardy - $5,000 Resident Surgical Skills Round-Up - $5,000
Company Representatives

email additional reps to janna@southtexasacs.org
Representative #1

First Name Last Name
Email #1
example@example.com
Cell Phone Number
Please enter a valid phone number.
On-Site Contact *
Representative #2

First Name Last Name
Email #2
example@example.com
Cell Phone Number
Please enter a valid phone number.
On-Site Contact *
Booth Assignment
Booths will be assigned at the sole discretion of show management and will be based on the date of request and consideration of competition. No specific booth guarantees will be made until payment is received.
Please indicate which companies should not be placed in close proximity to your booth location, South Texas ACS will attempt to recognize this request in booth placement, but cannot provide any guarantees:
Please indicate the products or services you will display: *
Payment Method
Choose Your Payment Method *
By Check

Please make check payable to the South Texas Chapter American College of Surgeons.

Print and submit this form then your check to:

So. Texas ACS
Attn: Janna Pecquet
2213 Danny Park
Metairie, LA 70001
By Credit Card *
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Exhibitor Level
$ 2,000.00

William J. Pokorny, MD Named Lecture
$ 1,000.00

Stump the Attendees
$ 1,000.00

Great Debates
$ 1,000.00

Networking Break
$ 1,250.00

Continental Breakfast
$ 1,500.00

Poster Session
$ 1,500.00

Resident & Governor Breakfast
$ 2,500.00

Attendee Lunch
$ 2,500.00

Meeting App + WiFi
$ 2,000.00

Women in Surgery Luncheon
$ 3,000.00

Resident Surgical Jeopardy
$ 5,000.00

Resident Surgical Skills Round-Up
$ 5,000.00

Additional Representatives
$ 150.00 Number

Electricity
$ 75.00

Total

$ 0.00
South Texas Chapter ACS Exhibitor Policies
I understand the SoTX-ACS exhibitor policies below: *

yes no
Liability/Insurance: Neither SoTX-ACS nor the hosting facility assume responsibility for any loss, injury or damage occurring to an exhibitor or any exhibitor’s property. It is the exhibitor’s responsibility to have their person and materials insured against theft, damage, loss or injury.

Cancellation: Cancellations will be accepted with written notice on or before January 5, 2022. After January 5, 2022, a 50% cancellation fee will be assessed.
Should be Empty:

Exhibitor Application Form

Company Information

Exhibitor & Event Sponsors

Company Representatives

Booth Assignment

Payment Method

South Texas Chapter ACS Exhibitor Policies