SAEM27 Industry Event Request Form
Sponsors wishing to host or support any meeting, reception, dinner, hospitality event, advisory board, product theater, customer event, or other gathering in conjunction with the SAEM Annual Meeting must submit an Industry Event Request Form for review and written approval by SAEM prior to contracting with a venue or promoting the event. Submission of an Industry Event Request Form does not constitute approval. SAEM reserves the right to approve, deny, or request modifications to any proposed event to avoid conflicts with official meeting programming, preserve the integrity of the educational program, and ensure compliance with SAEM Terms & Conditions. Approved events must comply with all applicable SAEM Terms & Conditions, venue regulations, and local laws. Sponsors are responsible for all costs associated with their event unless otherwise agreed to in writing by SAEM.
Event Location
Onsite (At the Annual Meeting Venue)
Offsite (External location)
Company Information
Company Name:
*
Primary Contact:
*
Title:
*
Email:
*
example@example.com
Phone:
*
Format: (000) 000-0000.
Date Requested
Preferred Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Alternate Date (if applicable):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Time
Start Time:
*
Hour Minutes
AM
PM
AM/PM Option
End Time:
*
Hour Minutes
AM
PM
AM/PM Option
Event Information
Name of Event:
*
Type of Event (check one)
*
Reception
Dinner
Breakfast
Lunch
Hospitality Suite
Advisory Board
Customer Meeting
Investigator Meeting
Networking Event
Product Demonstration
Other
Event Description
Please provide a brief description of the event and its purpose.
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Venue Information
Venue Name:
*
Room Name (if known):
Venue Address:
Attendance
Estimated Number of Attendees:
*
Target Audience
*
Physicians
Residents
Fellows
Medical Students
Researchers
Industry
Invitation Only
Other
Acknowledgements
Please initial each statement.
I understand this request is subject to SAEM approval.
*
I understand I may not advertise or promote this event until written approval has been received.
*
I understand my event may not conflict with official SAEM educational sessions or official meeting events.
*
I agree to comply with all SAEM Terms & Conditions and venue regulations.
*
I understand approval may be withdrawn if event details change without prior approval.
*
Signature
Authorized Representative
Name:
*
Title:
*
Signature:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SAEM Internal Use Only
Date Received
Reviewed By
Approval
Approved
Denied
Pending
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Conflict with SAEM Program?
Yes
No
Conflict with Sponsored Event?
Yes
No
Notes
Final Approval Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: