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ANCILLARY MEETING REQUEST FORM

    Indicates required field
Organization Name     
Meeting Date     
Organization/Institution Name     
Ancillary / Affiliate Contact Full Name     
Mailing Address     
City     
State     
Postal Code     
Phone     
Email     
.   
.   
MEETING / FUNCTION TYPE
Events affecting the IARS, AUA and SOCCA 2018 Annual Meetings attendees, who are outside of the educational programming, including but not limited to:
  
Board Meeting     
Committee Meeting     
Reception     
Reception / Dinner     
Check here if this meeting/function is educational in nature.     
Check here if this meeting/function has an invited speaker to present.     
If checked, please identify speaker and presentation title:     
Check here if marketing materials will be produced for this function/meeting.     
IARS requires review of all marketing materials prior to production and distribution for the proposed event.
  
.
  
PREFERRED MEETING / FUNCTION SPECIFICATIONS   
Meeting / Function Name     
Meeting / Function Description / Purpose     
Meeting / Function Date     
Meeting / Function Start Time     
Meeting / Function End Time     
Anticipated # of Attendees     
PREFERRED MEETING / FUNCTION SPACE ROOM SET   
 

SIGNATURE OF AGREEMENT

This application form is used to apply for function space approval. You will receive an email confirmation from the IARS office regarding your application. In the event the IARS approves your application, by signing below you agree to the Terms and Conditions outlined in the above Ancillary Meeting Request Form and not to use the IARS, AUA or SOCCA or IARS, AUA and SOCCA 2017 Annual Meetings names or logos in the promotion of this meeting/function. By approving your application, the IARS does not endorse or sanction your meeting/function, and no such relationship should be inferred by your affiliate organization and/or its agents or implied to your meeting/function participants.

  
Authorized Contact Signature – Approved by Signature     
Authorized Contact Full Name (Print Name)     
Date     

QUESTIONS? CONTACT THE MEETINGS AND EDUCATION DEPARTMENT

Attn: Meetings and Education Department
International Anesthesia Research Society
44 Montgomery St., Suite 1605
San Francisco, CA 94104
Phone: 415-296-6900
 
NOTE: Final space assignment will be based on availability.