MPBC Event Request
External Event Request
Name
*
First Name
Last Name
Email
*
example@example.com
How did you hear about MAPS Public Benefit Corporation?
Another individual (e.g. friend, coworker, partner)
Online Community (e.g. social media, forums, specific website)
In-Person or Online Event (e.g. convention)
Other
If you are affiliated with an organization, please enter the organization name below.
Please enter the full name of your event
*
Please choose the location of event
*
Please Select
In Person
Online
Hybrid (In Person and Online)
Please enter the address for in-person events.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please click on the date(s) you would like to have MPBC's participation?
Please choose the focus of the event (check all that apply)
*
Academic Conference
Community Event
Educational Event
Group Meeting/Presentation
Other
Please choose the primary audience of the event (check all that apply)
*
Healthcare Providers
Researchers
Payors
Patient Advocates
Policy Makers
Other
Please describe the primary objective of your event in one or two sentences.
*
Please provide a brief summary of your event.
*
Please add any attachments you'd like us to review in support of your event request.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please enter the web address of the event.
Please enter the approximate number of attendees (in-person and online).
*
Please select the type(s) of participation you'd like from MPBC (check all that apply).
*
Presentation/Speaker Engagement
Medical Booth
Commercial Booth
MPBC Sponsorship
Expert Panel Participant
Other
Is an honorarium being offered?
Yes
No
Not sure
Are you offering reimbursement for travel expenses?
Yes
No
Not sure
Submit
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