2025 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 Opportunities
Exhibitor Fee*

Primary Booth - $2,500Standard Booth - $2,000
Sponsorship & Promotional Opportunities
Choose One

Kick-Off Party - $2,000 (3 available)Breakfast Sponsor - $10,000Medical Student & Resident Breakout - $3,5008th Anesthesia Jeopardy Competition - $4,000
Special Requests
Please check if you need:*

Electrical - $85WiFi - $25Additional Badges - $175 eachNo special requests needed
List Companies you would prefer not to be located nearby (add N/A if you have no preference) *
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.

Credit Card

Exhibitor Level

Primary Booth

$2,500.00

Standard Booth

$2,000.00

Commercial Support

Kick-Off Party

$2,000.00

Breakfast Symposium

$10,000.00

Anesthesia Jeopardy

$4,000.00

Medical Student & Resident Breakout

$3,500.00

Special Requests

WiFi

$25.00

Electricity

$85.00

Additional Badges

$175.00 Number

Enter coupon

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, 2024. After February 1, 2024, a 50% cancellation fee will be assessed.
I understand the LSA exhibitor policies below:*

yesno
Should be Empty:

Exhibitor Registration Form