Anamatics/Assertio Reg

Assertio Advisory Board Meeting

Friday, September 20, 2024 - Saturday, September 21, 2024

Location: Hotel ZaZa Museum District

5701 Main St, Houston, TX 77005

Friday, September 20, 2024

All Day	Arrivals
7:00 pm - 9:00 pm	Welcome Session and Dinner

Saturday, September 21, 2024

7:00 am - 8:00 am	Breakfast
8:00 am - 8:15 am	Opening and Introductions
8:15 am - 10:00 am	Session 1: Medical Discussion (LGS Connect)
10:00 am - 10:15 am	Break
10:15 am - 12:00 pm	Session 2: Marketing - Sympazan (clobazam) Oral Film
12:00 pm	Departures, Boxed Lunches Available

Please check each activity that you will be attending

Will you Attend the Welcome Dinner on September 20, 2024?*

YesNo
Will you Attend Breakfast on September 21, 2024?*

YesNo
Do you have any dietary restrictions?*
Will you attend Session 1: Medical Discussion (LGS Connect) on September 21, 2024?*

YesNo
Will you attend Session 2: Marketing - Sympazan (clobazam) Oral Film on September 21, 2024?*

YesNo

Personal Information
Your Name [As It Appears On Your ID]*

PrefixFirst NameMiddle NameLast NameSuffix
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email Address*
example@example.com
Best Contact Phone Number: *

Flight Request
Please note, due to compliance, all travel must be booked through Anamatics on behalf of Assertio*

Yes, provide request now with your registrationNo flight arrangements required
Departing From:
Arriving To:
Departure Date:

MonthDayYear
Return Date:

MonthDayYear
Your Name [As It Appears On Your ID]

PrefixFirst NameMiddle NameLast NameSuffix
Date of Birth [As It Appears On Your ID]

MonthDayYear
Date
Gender [As It Appears On Your ID]
Frequent Flier #
TSA PreCheck/Known Traveler Number (KTN)#
Preferred Seat
Preferred Departure Time(s)

Early Morning (12AM-5:59AM)Morning (6AM-11:59AM)Afternoon (12PM-4:59PM)Evening (5PM-8:59PM)Late Evening (9AM-11:59PM)
Preferred Return Time(s)

Early Morning (12AM-5:59AM)Morning (6AM-11:59AM)Afternoon (12PM-4:59PM)Evening (5PM-8:59PM)Late Evening (9AM-11:59PM)
Do you require ground transportation to/from the Houston Area Airport?*

YesNo

Hotel Request
Do you require hotel accomodations for the night of Friday September 20, 2024?*

YesNo
Please upload your CV (required) and an optional headshot*

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