2025 ATOPP Summit Ancillary Event Application

Ancillary Event Application

2025 ATOPP Summit
Company Name*
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Advisory Boards & Focus Groups
A Basic Logistics package is required for all advisory boards/focus groups. A non-refundable $150 application fee is also included.

You may choose to upgrade to a Full Service comprehensive content support package to customize your experience and create a truly valuable event.
Please select the Ad Board/Focus Group you wish to sponsor from the drop down menus below and select your chosen package.
Ad Board/Focus Group, 1-hour
Ad Board/Focus Group, 2-hour
Ad Board/Focus Group, 3-hour
Ad Board/Focus Group, 4-hour
Satellite Symposia
A Basic Logistics package is required for all non-accredited satellite symposia. A non-refundable $150 application fee is also included.

You may elect to offer your symposium as an accredited program for continuing pharmacy education (CPE). If CPE will be offered, a Continuing Education package will be required, whereby CE Synergy will provide all accreditation management services.
Please select the Satellite Symposium type you wish to sponsor from the drop down menus below:
Please provide the title and objectives of the symposium:
If known, please provide the name, title, and employer of symposium speaker:

First NameLast Name
Title
Employer
2nd name, title, and employer of symposium speaker (if needed):

First NameLast Name
Title
Employer
Pre-Approval Information Exchange (PIE) Session
Note: The PIE Sessions are full. Please email events@atoppsummit.com to be placed on a waitlist.
Sponsorship Credit
If your company is supporting the ATOPP Summit as a Platinum, Gold, or Silver corporate sponsor, will you be applying your Sponsorship credit to this event (Platinum $20,000, Gold $10,000, Silver $5,000)?*

YesNoUnknown
Payment
If there is a different contact for payment and other logistical inquiries, please put their name and email here:

First NameLast Name
Email
example@example.com
Payment Option*

Check (See below for mailing address)Credit Card*ACH/Bank Transfer (Banking information will be sent separately)
Total Amount:*
Mail Payment To:
CE Synergy, LLC
c/o Terri Davidson
305 W. Country Drive
Johns Creek, GA 30097

Tax ID No: 35-2635885
Tel: 678-584-9502
Cell: 678-481-2563
Email: events@atoppsummit.com

Requests are per event and include a single room. A separate application must be submitted for each event. If your event requires more than one room, please email events@atoppsummit.com.

*Credit card payments will be accepted on a case-by-case basis. Note there is a 3% credit card fee. Please email events@atoppsummit.com for more information.

Acknowledgement: I acknowledge I am an authorized representative of the above Sponsor and can legally enter into this contract. This sponsor application will become a contract upon Sponsor’s authorized signature and CE Synergy’s acceptance and approval.

Cancellation Policy: In the event that the ATOPP Summit is cancelled by the ATOPP organizers/CE Synergy for any reason, sponsor may, upon written request to CE Synergy within 60 days of receiving notice of the postponement or modification, choose to: (a) apply the sponsorship fees toward the new date(s) or format; or (b) receive a refund of sponsorship fees paid, less a pro rata share of conference expenses as calculated by CE Synergy. In the event that sponsor cancels its participation for any reason, sponsorship payments are non-refundable.

Release Statement: I agree to release, indemnify, defend, and hold harmless the ATOPP Summit Organizers, CE Synergy, LLC, and their agents and contractors from any and all claims, demands, damages, expenses, losses, fines, penalties or liabilities, arising from conducting an Ancillary Event in conjunction with the 2025 ATOPP summit as described in the 2025 ATOPP Summit Ancillary Event Guide.
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Date*

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Ancillary Event Application

Advisory Boards & Focus Groups

Satellite Symposia

Pre-Approval Information Exchange (PIE) Session

Sponsorship Credit

Payment