2025 Exhibitor Registration Form

Exhibitor Registration Form
Company Information
Company Name*
How it will be listed in the final program and signage
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.
Fees
Commercial Promotion*

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

Networking Break - $1,250 (3 available)Continental Breakfast - $1,500 (one available)Poster Session - $1,500 (3 Available)Speed Mentoring - $3,500 (with Medical Students & Residents)Attendee Lunch - $2,500Women in Surgery Cocktail Hour - $3,500Resident Surgical Jeopardy - $5,000Exclusive Resident Surgical Skills Round-Up - $7,500
Special Requests
Please check if you need:*

Electrical - $50WifI - $50 per connectionAdditional Badges - $150 eachShipping & Receiving - company expense; will send info once this form is receivedAV equipment - company expense; will send info once this form is receivedNo 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*
Additional Badge #3

First NameLast Name
Email #3
example@example.com
Cell Phone Number
Please enter a valid phone number.
On-Site Contact*
Additional Badge #4

First NameLast Name
Email #4
example@example.com
Cell Phone Number
Please enter a valid phone number.
On-Site Contact*
Additional Badge #5

First NameLast Name
Email #5
example@example.com
Cell Phone Number
Please enter a valid phone number.
On-Site Contact*
South Texas Chapter ACS Exhibitor Policies
Liability/Insurance: Neither South Texas Chapter 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 December 10, 2024. After December 10, 2024, a 50% cancellation fee will be assessed.
I understand the South Texas ACS exhibitor policies above:*

yesno
Payment Method
Choose Your Payment Method*
By Check
Please make check payable to the STC-ACS

Print and submit this form and mail with your check to:

STC-ACS
2213 Danny PK
Metairie, LA 70001

Email: janna@southtexasacs.org
Phone: 504-841-0145
Fax: 504-335-2266
By Credit Card

Should be Empty:

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

Exhibitor Registration Form

Company Information

Fees

Special Requests

Exhibitor Registration

South Texas Chapter ACS Exhibitor Policies

Payment Method

By Check

By Credit Card