Fujifilm Endoscopy Event Request Acknowledgement

Event Request
FUJIFILM Healthcare Americas Corporation (Fujifilm) looks forward to the opportunity to host a designated booth, table, or other space devoted to our Endoscopy, Pulmonary, and/or Endosurgical product lines at your upcoming event.

As you fill out the required Exhibit request application below for consideration, note that Exhibit, Educational Grant, and In-Kind Equipment applications need to be submitted, reviewed, and approved as separate requests. In addition, for the purpose of these applications, all events must take place in the United States of America.

At Fujifilm, we appreciate your application. We receive many worthwhile requests, and unfortunately, due to budget limitations, we are unable to fund them all. Please note that past funding of an event does not guarantee funding approval of your current event application. Applications may also be approved at an amount less than the requested amount. Additional questions or information beyond this form may also be required to process your application.

Do not assume that an application has been approved because it has been submitted. Requestors will receive an email notification of approval or denial of their application.
* Required Fields & Required Documents
Event Contact Information
Event Contact Name*

First NameLast Name
Title*
Company*
Email*
example@example.com
Phone Number*
Event Details
Name of Event*
Event Date*

MonthDayYear
Date
Venue*
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Website*
Description of event (including goals and objectives)*
Number of expected conference attendees*
Shipping Information & Contact
Shipping Address Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping Contact Name*

First NameLast Name
Shipping Contact Email*
example@example.com
Shipping Contact Phone*
Special Shipping Logistics (Select All That Apply)

Loading DockLift GateStorage for crates/equipmentShipping Hours
Additional Shipping Information:
(Shipping Hours, Shipping Forms, etc.)
Is this event located at a Hotel?*

YesNo
Hotel Contact
Hotel Contact Name

First NameLast Name
Hotel Contact Email
example@example.com
Hotel Contact Phone Number
Logistic Information

If Applicable - Please Complete the Below
Location Type*

VenueConvention CenterHotel
Venue Contact Name

First NameLast Name
Venue Contact Email
example@example.com
Venue Contact Phone Number
Is there an Exhibitor Kit/ General Contractor (ex: GES, Freeman) associated with this event?*

YesNo
If yes, please upload Service Kit.

Browse Files

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Additional Information
Exhibit Set Up*
Exhibit Tear Down*
Is electric included?*

YesNo
If no, please upload electrical form in upload of documents.

Browse Files
If no, please upload electrical form in upload of documents.) Cancelof
Any additional information
(ex: Room Location, Badge pick up information, anything else to share related to the event.)
Upload Documents
Browse Files
Upload files from your device to the form. Cancelof
Event Request Form Requirements:
1. A completed FUJIFILM Healthcare Americas Corporation Exhibit Request Application using our submission form:
  Please note: Apply at least 90 days prior to event start date.
1. Exhibit or Sponsorship Agreement:
  - Exhibit or Sponsorship Agreement that outlines exhibit table/booth size, commercial benefits, and terms and conditions
1. A letter of request on the program provider’s letterhead that includes:
  - Exhibit prospectus, (description of exhibit space),agenda, brochure, etc.
  - Description and number of expected conference attendees (e.g., focus group)
1. Levels of sponsorship and associated benefits, if applicable.
1. Completed W-9 form
1. Additional Forms (Electrical Form, Shipping Form)
Should be Empty:

Event Request

Event Contact Information

Event Details

Shipping Information & Contact

Hotel Contact

Logistic Information

Additional Information

Upload Documents