2025 Exhibitor Registration Form

Exhibitor Registration Form

2025 LA-ACS Annual Meeting
Company Information
Company Name*
How you want it listed in the program
Main Contact Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Commercial Promotion Fees
Choose One*

Exhibitor Booth - $2,000Exhibit Booth + Surgical Skills - $2,500Bronze Level - $3,500Silver Level - $5,500Gold Level - $7,500Platinum Level - $10,000
Commercial Support

Networking BreakContinental BreakfastePoster SessionSpeed Mentoring (with Medical Students & Residents)Attendee LunchSurgical Skills Competition Happy HourResident Surgical JeopardyExclusive Resident Surgical Skills Round-Up
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Special Requests
Please check if you need:*

Electrical - $50Additional Badges - $150 eachNo special requests needed
List Companies you would prefer not to be located nearby
Please indicate the products or services you will display
Exhibitor Registration

Additional badges needed? Email janna@laacs.org with their information.
Complimentary Badge #1

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

First NameLast Name
Email #2
example@example.com
Cell Phone Number
Please enter a valid phone number.
On-Site Contact*
Payment Method
Choose Your Payment Method*
By Check

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

Print and submit this form then your check to:

LA-ACS
Attn: Janna Pecquet
2213 Danny Park
Metairie, LA 70001

For more information, please contact Janna Pecquet
Email: janna@laacs.org.

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

LA-ACS Exhibitor Policies
Liability/Insurance: Neither LA-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 31, 2025. After January 31, 2025 a 50% cancellation fee will be assessed.
I understand the LA-ACS exhibitor policies below:*

yesno
Should be Empty:

Exhibitor Registration Form

Company Information

Commercial Promotion Fees

Special Requests

Exhibitor Registration

Payment Method

LA-ACS Exhibitor Policies