2023 LSA Exhibitor Registration Form

Exhibitor Registration Form
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.
Exhibitor + Marketing Opportunities
Choose One*

Exhibitor Fee - $2,000Kick-Off Party - $3,500Lunch in Exhibit Area - $3,000Women In Anesthesia Luncheon - $3,000Charging Station - $2,500Medical Student & Resident Breakout - $2,500
Special Requests
Please check if you need:*

Electrical - $50WiFi - $25Additional Badges - $150 eachNo special requests needed
List Companies you would prefer not to be located nearby
Exhibitor Registration
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 Society of Anesthesiologists.

Print and submit this form then your check to:

LSA
Attn: Janna Pecquet
2213 Danny Park
Metairie, LA 70001

For more information, please contact Janna Pecquet
Email: janna@lsahq.org.
By Credit Card*
Categories:All

All

Exhibitor Level

Commercial Support

Special Requests
prevnext( X )
Exhibitor Level

Exhibitor Level
$2,000.00



Commercial Support

Kick-Off Party
$3,500.00



Lunch in Exhibit Area
$3,000.00



Women In Anesthesia Luncheon
$3,000.00



Anesthesia Jeopardy
$3,000.00



Charging Station
$2,500.00



Medical Student & Resident Breakout
$2,500.00



Special Requests

WiFi
$25.00



Electricity
$50.00



Additional Badges
$150.00 Number



Total

$0.00
LSA Exhibitor Policies
Liability/Insurance: Neither LSA 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 February 1, 2023. After February 1, 2023, a 50% cancellation fee will be assessed.
I understand the LSA exhibitor policies below:*

yesno
Should be Empty:

Exhibitor Registration Form

Company Information

Exhibitor + Marketing Opportunities

Special Requests

Exhibitor Registration

Payment Method

LSA Exhibitor Policies