Dear Industry Colleagues:
Course Director On behalf of Department of Urology at the Icahn School of Medicine at Mount Sinai Hospital in Ash Tewari, MBBS, MCh New York City, I would like to invite you to partner with the Second International Prostate Co –Directors Cancer Symposium and Inaugural World Congress of Robotic Oncology being held on Ketan K. Badani, MD September 6-9, 2017 at Mount Sinai Hospital in New York, New York. Ranked among the Nina Bhardwaj, MD, PhD nation’s best for Urology in the 2016-2017 "Best Hospitals" issue of U.S. News & World Carlos Cordon-Cardo, MD, PhD Report, the physicians of Mount Sinai Urology Associates are leaders in robotic surgery and William Oh, MD minimally invasive procedures to treat prostate, kidney, and bladder cancers. The Mount Sinai Site Directors Urology team is also on the forefront of diagnosis and treatment for urinary tract and prostate Mantu Gupta, MD disorders, erectile dysfunction, kidney stones, infertility, and pediatric urologic conditions. Michael A. Palese, MD Join the Mount Sinai Department of Urology for an interactive symposium with 3D demonstration of the latest robotic surgery techniques for prostate, kidney and bladder cancer. Directed by the world’s leading robotic experts and taught by an internationally renowned faculty, attendees gain emerging and practical tools to optimize their robotic surgical skills. Highlights include 3D viewing of robotic surgeries including prostate, kidney, bladder and
reconstruction, point-counterpoint debates and inaugural address by Dennis Charney, MD,
Dean of the Icahn School of Medicine at Mount Sinai.
Affiliating with the Second International Prostate Cancer Symposium and Inaugural World Congress of Robotic Oncology is the most direct route in meeting with and sharing your products with some of the most well-known and respected health care providers and decision makers in the urological community. As an essential part of the symposium, you will be able to place your product in the hands of key opinion leaders in the field and encourage new and existing relationships.
Please review the 2017 Partnership Prospectus and reserve your prime exhibit space today to participate in this cutting-edge urologic oncology conference. We look forward to having you as our industry partner. More information can be found at Mountsinaiurologycme.org or if you have questions please call Christina Espiritu at (847)892-7641 or via email at [email protected].
Sincerely,
Christina C. Espiritu Director of Specialty Programs Veritas Meeting Solutions | 2575 Northwest Parkway | Elgin, Illinois 60124 W: (847)892-7641 | F: (224)888-2661 | [email protected] Mountsinaiurologycme.org
PARTNERSHIP INFORMATION
GENERAL INFORMATION Payment is due no later than August 1, 2017 The World Congress of Robotic Oncology will provide attendees with Continuing Medical Education (CME) in Cancellations & Refunds: addition to advanced knowledge with a multi-disciplinary Our administrative office requires that all cancellations must robotics surgical focus, combined with new product be in writing. The following refund schedule applies: knowledge learned in the exhibit hall. • Cancellation on or prior to August 1, 2017, your exhibit fee will be refunded less a $250 administration fee. Official Meeting Dates: September 6-9, 2017 • Cancellation after August 1, 2017; no portion of the Official Exhibit Dates: September 6-9, 2017 original exhibit fee will be refunded. MEETING LOCATION Assignment of Space: The Mount Sinai Hospital Exhibit space will be assigned at the sole discretion of the 1 Gustave L. Levy Place Congress. Factors affecting exhibit location include support New York, NY 10029-6574 level; the sign-up and payment date of the application, the number of exhibits, and proximity of competitors. SUPPORTING MOUNT SINAI UROLOGY EXHIBIT SCHEDULE Deliver your message in a professional, focused, and The schedule below is for companies that will be educational environment. The World Congress of Robotic participating at this meeting. Oncology provides you with networking opportunities to Times are subject to change without notice build relationships with new and existing customers. Choose a standard exhibit booth or a promotional partnership Exhibit Set-Up: package, which provides extended promotional visibility for Wednesday, September 6, 2017 8:00am – 12:00pm your company beyond the annual meeting. Exhibit Hours: Wednesday, September 6, 2017 1:00pm – 5:00pm EXHIBITING Thursday, September 7, 2017 6:30am – 5:30pm The expected 100 attendees want to meet you face-to-face Friday, September 8, 2017 6:30am – 4:00pm and examine your products first-hand. By exhibiting at the Saturday, September 9, 2017 6:30am – 6:00pm meeting, your company will be listed in promotional Exhibit Teardown: materials and the onsite program book. Space is limited, so Saturday, September 9, 2017 After 6:00pm act quickly! Registration: PROMOTIONAL PARTNERSHIP PACKAGES Only employees of the exhibiting company, or its agents, will Secure a prime exhibit location and optimum visibility with a be issued a badge. Booths must be manned the entire time the Pinnacle, Platinum, Gold, Silver, or Bronze Level Partnership exhibit area is open. package. In addition to your exhibit, participation in this program includes the pre-attendee registration list, your company logo and recognition in the annual meeting program For more information about exhibits, sponsorships, book, signage and more. Please refer to the Promotional or advertising opportunities to support the Second Partnership details in this prospectus for a complete list of International Prostate Cancer Symposium and Inaugural benefits. World Congress of Robotic Oncology through an educational grant, please contact: Exhibit Description: One 6-foot table with two chairs and a wastebasket. Christina C. Espiritu Additional service information will be made available Director of Specialty Programs approximately three to four weeks prior to the meeting. Veritas Meeting Solutions 2575 Northwest Parkway; Elgin, Illinois 60124 W: (847)892-7641 F: (224)888-2661 [email protected] Mountsinaiurologycme.org
Pinnacle Platinum Gold Silver Bronze Exhibit SECOND INTERNATIONAL PROSTATE CANCER SYMPOSIUM Level Level Level Level Level Only AND INAUGURAL WORLD CONGRESS OF ROBOTIC ONCOLOGY $50,000 $40,000 $30,000 $20,000 $10,000 $5,000 Promotional Partnership Benefits – Listed below are the benefits associated with each level Please select your level of support by indicating the amount in this row Full Page Black & White Ad in the Exhibit Guide INCLUDED INCLUDED Half-Page Black & White Ad in the Exhibit Guide INCLUDED INCLUDED INCLUDED INCLUDED Opportunity to host a Full-Day Program (Hands-On) during the INCLUDED meeting. (Meeting Room and Basic A/V included) TICKETS Six Complimentary Registrations INCLUDED INCLUDED Four Complimentary Registrations INCLUDED Two Complimentary Registrations INCLUDED INCLUDED ADVERTISEMENTS and MAILINGS One-Time Use of Attendee Mailing Labels INCLUDED INCLUDED INCLUDED INCLUDED (piece must be pre-approved by administrative office) Pre-Registration Attendee List INCLUDED INCLUDED INCLUDED INCLUDED Post Meeting Attendee List INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED RECOGNITION Company Logo Displayed on the Website INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED Company Logo Displayed on Signage INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED Company Logo Displayed in the Newsletter INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED Company Signage Recognized on the Website INCLUDED INCLUDED INCLUDED INCLUDED Company Sponsorship Recognized on Signage INCLUDED INCLUDED INCLUDED INCLUDED Company Sponsorship Recognized in Exhibit Guide INCLUDED INCLUDED INCLUDED INCLUDED EXHIBITING & BADGES Prime Booth - Unlimited Exhibit Attendee Badges INCLUDED INCLUDED Featured Booth - 6 Exhibit Badges INCLUDED Standard Booth - 4 Exhibit Badges INCLUDED INCLUDED INCLUDED ADDITIONAL EVENT TICKETS Welcome Reception with each Exhibit Attendee Badge INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED ADDITIONAL ADVERTISING AND SPONSORSHIP OPPORTUNITIES Opportunity Description Please select your opportunities by Cost (See Guidelines Page for Further Details) marking the amount below Industry Sponsored Speaker Presentation $25,000 Poster Pavilion Sponsorship (Exclusive) $25,000 (Company Logo Displayed on GOBO) Wireless Code for Meeting Space (Exclusive) $25,000 (Company Logo and Code Displayed on GOBO in Meeting Space) Partial Sponsorship of the Welcome Reception in the Exhibit Hall $25,000 (Company Logo Displayed on GOBO During Reception) Full Color Ad on Back Cover or Inside Front Cover of the Exhibit Guide $10,000 (Location selection on a first come-first served basis) Company Logo with Welcome Message on GOBO in Featured Location in Meeting Space $10,000
Schedule-At-A-Glance Sponsorship $7,500
Attendee Arrival Bags Distributed at Registration (Exclusive) $7,500 Full Page Black & White Ad in the Exhibit Guide $5,000 Half-Page Black & White Ad in the Exhibit Guide $2,500
TOTAL Sponsorship Level (From Top Table) TOTAL from Additional Advertising and Sponsorship Opportunities (From This Table) GRAND TOTAL of SPONSORSHIP
ADVERTISING & DIGITAL SUBMISSION GUIDELINES
Full Page Advertisement in Exhibit Guide – This advertisement should be in portrait orientation. The specifications for the advertisement are 8.5” wide x 11” high with a ¼” bleed. The image should be black and white and should be sent in a high-resolution PDF format. Deadline is August 1, 2017.
Half-Page Advertisement in Exhibit Guide – This advertisement should be in landscape orientation. The specifications for the advertisement are 8.5” wide x 5.5” high with a ¼” bleed. The image should be black and white and should be sent in a high-resolution PDF format. Deadline is August 1, 2017.
Schedule-at-a-Glance – The Schedule-at-a-Glance is a smaller, less detailed schedule that can easily fit in an attendee’s name badge or pocket and allows for a quick-look at the program without having to flip through the program book. For this sponsorship, we will need to have a high-resolution file of your company logo in an EPS format. Deadline is August 1, 2017.
Welcome Reception Partial Sponsorship – Partial sponsorship of the Welcome Reception is one of the most highly visible ways to support the Second International Prostate Cancer Symposium and Inaugural World Congress of Robotic Oncology on the wall of the exhibit hall during the Welcome Reception. The administrative office for the Congress will handle production costs and logistics associated with this sponsorship. Logo will be displayed in color. Please send a high resolution full-color PDF of your organization logo no later than August 1, 2017.
Please send all creative materials listed above for approval to: Christina Espiritu at [email protected]
ADVERTISING & DIGITALAGENDA SUBMISSION GUIDELINES
WEDNESDAY, SEPTEMBER 6TH
13:15-13:30 Push Up Challenge
13:30-13:45 Dean Welcome and Chairs Welcome
13:45-14:00 Last 75 years Journey (Achievements, Chairs, Voluntaries) Michael Droller
14:00-14:20 Stone Center Mantu Gupta
14:20-14:40 Men’s Health Program Steven A. Kaplan
14:40-15:00 Sexual Medicine Robert Valenzuela
15:00-15:20 Reconstructive Urology Rajveer Purohit
15:20-15:40 Intervention Urology Ardeshir Rastinehad
15:40-16:00 Pediatric Urology Jefferey Stock
16:00-16:20 Precision Urology Michael Donovan
16:20-16:40 GU Immunotherapy Sujit Nair
16:40-17:00 Close of Meeting TBD
THURSDAY, SEPTEMBER 7TH
MAIN ROOM
7:20-7:30 Introduction Ash Tewari
SESSION I SCREENING & LOW RISK DISEASE Moderator: Vincent Laudone
7:30-8:00 How Nerve Sparing Changed the Outcome of Prostate Cancer Patrick Walsh
8:00-9:00 Live Surgery Moderator: Ketan Badani Panel: Thomas Ahlering, Giuseppe Carrieri, Michael Palese
9:00-9:10 Epidemiology Lorelei Mucci
AGENDAAGENDA continued
9:10-9:25 Screening For Prostate Cancer Fritz Schröder
9:25-9:35 USPTF Recommendations Badrinath Konaty
9:35-10:10 Genomic Complexity of Prostate Cancer Ash Tewari
10:10-10:40 Immunotherapy in Prostate Cancer James Gulley
10:40-10:55 Emerging Role of MRI for Screening: PROMIS Trial Mark Emberton
10:55-11:05 Emerging Role of Genomics Leonard Gomella
11:05-11:15 Novel Biomarkers Badrinath Konety
11:15-11:35 Active Surveillance Peter Carroll
11:35-11:55 Debate: Genomics vs. MRI in Risk Stratification Eric Klein vs. Ardeshir Rastinehad
11:55-12:05 Neurosafe: European Experience Alexander Haese
12:05-12:15 Neurosafe: US Experience Kenneth Haines
12:15-13:00 LUNCH BREAK
13:00-14:00 LIVE SURGERY Moderator: Vip Patel Panel: Badrinath Konety, Christopher Porter, Ronney Abaza
SESSION II FOCAL THERAPY Moderator: Mark Emberton
14:00-14:10 Prostate MRI: What Urologists Should Know Bachir Taouly
14:10-14:20 3D Mapping Biopsy Nelson Stone
14:20-14:30 Targeting Strategies Arnauld Villers
14:30-14:50 Fusion Biopsy Peter Schulam
AGENDAAGENDA continued
14:50-15:00 Focal Therapy & Index Lesion Dipen Parekh
15:00-15:10 Focal Therapy: Is it ready for prime time? Herbert Lepor
15:10-15:20 HIFU: UK Experience Mark Emberton
15:20-15:30 HIFU: From Early Days to Present Stefan Thüroff
15:30-15:40 Gold Nanoparticle Ardeshir Rastinehad
15:40-15:50 COFFEE BREAK
SESSION III TREATMENT FAILURE Moderator: Jorn Witt
15:50-16:00 Biochemical Failure Management Michael Cookson
16:00-16:10 Adjuvant vs. Salvage RT John Davis
16:10-16:20 Role of Salvage Extended LND in BCR Axel Heidenreich
16:20-16:30 Salvage RALP Vip Patel
16:30-16:40 Salvage Cryotherapy Aaron Katz
16:40-17:00 Debate: Salvage RALP vs. Cryotherapy Moderator: Ketan Badani RALP: Jim Porter, Vip Patel Cryotherapy: Aaron Katz, Dipen Parekh
17:00-17:10 Novel Therapies For Recurrence Brian Francis Chapin
SMALL ROOM
SESSION I IMMUNOTHERAPY & TUMOR MICROENVIRONMENT Moderator: Sasha Gnjatic
13:00-13:10 Role of tumor microenvironment and immune-suppressive pathways in localized and aggressive cancer Meriam Merad
13:20-13:50 Immune checkpoint inhibitors for Bladder Cancer Matthew Galsky
AGENDAAGENDA continued
13:50-14:10 Dendritic Vaccine platforms for Cancer Immunotherapy Oncogenomics and Neo-antigen discovery Nina Bhardwaj
14:10-14:20 COFFEE BREAK
14:20-14:40 Biomarkers and Immunotherapy Susan F. Slovin
14:40-15:00 Next generation platforms for Immune Monitoring Sacha Gnjatic
15:00-15:15 Success of Immunotherapy- Lessons learned from Inflamed and Noninflamed cancers
15:15-15:30 Clinical Integration of Neo-adjuvant platforms for prostate cancer immunotherapy and TCR vaccines for GU cancer Ashutosh Tewari
15:30-16:00 Panel Discussion Moderator: Dr. Tewari Panel: Nina Bhardwaj, Matthew Galsky, Susan Slovin, Miriam Merad, Sasha Gnjatic
16:00-16:10 COFFEE BREAK
SESSION II IMMUNO-ONCOLOGY Moderator: Nina Bhardwaj
16:10-16:25 MAGE TCR Rajul Jain
16:25-16:40 Onco-immunology advances at Novartis Glen Dranoff
16:40-16:55 Advances in Immunotherapeutics and Onco-immunology Platforms Jun Liu
FRIDAY, SEPTEMBER 8TH
MAIN ROOM
SESSION I RADICAL PROSTATECTOMY Moderator: Manoj Monga
07:00-07:10 Surgical Anatomy of Prostate Atsushi Takenaka
07:10-07:20 Neural Supply of the Male Urethral Sphincter Thomas Bessede
07:20-07:50 Foundations of Anatomic RALP - Continence Ash Tewari
07:50-08:00 3D Imaging and Treatment Planning Francesco Porpiglia
AGENDAAGENDA continued
08:00-09:00 Live Surgery Moderator: Thomas Ahlering Panel: Dipen Parekh, John Davis, Jean Joseph, Francesco Porpiglia
9:00-9:10 Continence Sparing Techniques Thomas Ahlering
9:10-9:20 Nerve Sparing Techniques Vip Patel
09:20-09:30 Newer techniques in RARP/Fluorescent Guided Surgery Ashok Hemal
09:30-9:40 Pelvic LND for prostate cancer - Worth the Full Effort or Skip? John Davis
09:40-09:50 Extraperitoneal RP Jean Joseph
09:50-10:00 Perineal RP Jihan Kaouk
10:00-10:20 Journey of Robotic Surgery Mani Menon
10:20-10:30 COFFEE BREAK
SESSION II TREATING LOCALIZED DISEASE Moderator: Rakesh Kapoor
10:30-10:40 Active Surveillance Deepak Kapoor
10:40-10:50 Brachytherapy Richard Stock
10:50-11:00 Focal Therapy Aaron Katz
11:00-11:10 Radical Prostatectomy Prasanna Sooriakumaran
11:10-11:20 Radiotherapy Michael Zelefsky
11:20-11:40 Debate: Radical Prostatectomy vs. Radiotherapy RP: Prasanna Sooriakumaran RT: Michael Zelefsky
11:40-12:00 Debate: Focal Therapy vs. Active Surveillance FT: Aaron Katz AS: Deepak Kapoor
12:00-13:00 LUNCH BREAK
AGENDAAGENDA continued
13:00-13:45 Anatomical Foundations of RP – Nerve Sparing Ash Tewari
13:45-14:45 LIVE SURGERY Moderator: Mani Menon Panel: Craig Nobert, Prasanna Sooriakumaran, Jim Porter, Khurshid Guru
SESSION III ADVANCED PROSTATE CANCER Moderator: Bobby Liaw
14:45-15:05 Disseminated Tumor Cells at the Time of Radical Prostatectomy - What is the real incidence? Kenneth Pienta
15:05-15:15 Functional Genomics Eric Shadt
15:15-15:30 PTEN Signaling and Metabolism Ramon Parsons
15:30-15:50 DNA Damage and Repair Philip Kantoff
15:50-16:00 Gene-Oncogene Interactions Carlos Cordon-Cardo
16:00-16:10 Prostate Cancer Heterogeneity Ganesh Palapattu
16:10-16:20 ADT and Castration Resistance William Oh
16:20-16:30 Castration Resistance and Chemotherapy Matthew Galsky
16:30-16:40 PSMA Targeted Therapy Daniel Petrylak
16:40-16:50 Multimodal Treatment Paradigm in early Metastatic Prostate Cancer Vincent Laudone
16:50-17:00 Role of Prostate Cancer Foundation In Supporting Prostate Cancer Research Jonathan Simons
17:00-17:10 Leveraging Philantropy and Promoting Top 10 Ideas For Research in Prostate Cancer Howard Soule
17:10-17:20 Best Poster Award
17:20-17:30 Intuitive Talk Gary Guthard
AGENDA continued
SMALL ROOM
SESSION I LOCALLY ADVANCED DISEASE Moderator: Kenneth Rozenveig
14:00-14:10 Role of RT For High Risk Disease Richard Stock
14:10-14:20 Role of ADT with RT Michael Zelefsky
14:20-14:30 Role of PSMA In Locally Advanced Disease Markus Hohenfellner
14:30-14:40 Cyberknife Jonathan Haas
14:40-14:50 IMRT Shawn Zimberg
14:50-15:00 Proton Beam Therapy Richard Stock
15:00-15:15 Debate: Cyberknife vs. IMRT Cyberknife: Jonathan Haas IMRT: Shawn Zimberg
15:15-15:25 Neoadjuvant Chemotherapy Trials Brian Francis Chapin
15:25-15:35 COFFEE BREAK
SESSION II QUALITY OF LIFE Moderator: Victor Nitti
15:35-15:45 Penile Rehabilitation and Pharmacologic Treatment of ED Natan Bar-Chama
15:45-15:55 Penile Implantation Post-RP Robert Valenzuela
15:55-16:05 Urethral Stricture Management Rajveer Purohit
16:05-16:15 Urinary Incontinence & Nerve Regeneration Anthony Atala
16:15-16:25 Post-RP Incontinence Management Victor Nitti
16:25-16:40 Debate: PFMT vs. Early Sling vs. AUS Panel: Neil Grafstein, Steve Kaplan, Victor Nitti
16:40-16:50 LUTS after RALP & RT Jerry Blaivas
AGENDAAGENDA continued
16:50-17:00 QoL and Lifestyle Changes - General Health Perpective Jefferey Mechanick
17:00-17:10 QoL and Lifestyle Changes - Urology Perspective Philippa Cheetham
17:10-17:20 Complications in Robotic Surgery Daniel Gainsburg
SATURDAY, SEPTEMBER 9TH
KIDNEY CANCER I - Michael Palese, Ashok Hemal
7:00-7:05 Welcome and Program Overview – Badani
7:05-7:25 Keynote Speech Guest Speaker TBD
7:25-7:50 Debate: Small renal mass biopsy Pro: Jaime Landman Con: Ronney Abaza
7:50–8:15 Panel Discussion on Management of Renal Cancer Presenter: Chandru Sundaram Panel: Jihad Kaouk, Jaime Landman, Ketan Badani, Rene Sotelo
8:15–8:40 Debate: Transperitoneal vs. Retroperitoneal Partial Nephrectomy Transperitoneal: Jihad Kaouk Retroperitoneal: Jim Porter
8:40-8:55 Tips and Tricks of Urinary Reconstruction Daniel Eun
8:55-9:05 COFFEE BREAK
KIDNEY CANCER II – Moderators: Reza Mehrazin, Chandru Sundaram
9:05–9:30 Debate: Partial vs. Radical Nephrectomy for cT1b and cT2 Renal Masses with Normal Kidney Function Pro: Alex Mottrie Con: Dipen Parekh
9:30–9:40 Complications of RAPN Ketan Badani
9:40-10:05 Challenging cases and management strategies Moderator: Rene Sotelo Panel: Ketan Badani, Daniel Eun, Francesco Porpiglia, Jim Porter
10:05-11:30 Live Surgery Panel: Alex Mottrie, Aneesh Srivastava, Daniel Eun, Ashok Hemal
11:30–11:40 Complex robotic radical nephrectomy and IVC Thrombectomy Ronney Abaza
11:40-11:50 Adjuvant Therapy for High Risk RCC (S-TRAC trial) Nikhil Waingankar
AGENDAAGENDA continued
11:50–12:50 LUNCH BREAK
Kidney Session III – Moderators: Nikhil Waingankar, James Porter
12:50-13:50 Live/SEMI Live Surgery – Badani PANEL: Kaouk, Abaza, Parekh
13:50–14:00 RCC Tumor heterogeneity and Personalized Medicine Ari Hakimi
14:00-14:10 Transitions and sequencing of latest therapies in advanced RCC Che-Kai Tsao
14:10-14:20 Role of Cytoreductive Nephrectomy in the Targeted Therapy Era Isuru Jayaratna
14:20–14:30 COFFEE BREAK
Bladder Cancer I - Moderators: Michael Cookson, Khurshid Guru
14:30-14:35: Welcome Peter Wiklund
14:35-14:45 NBI vs. Blue Light Cystoscopy Mark Schoenberg
14:45-15:10 Debate: Management of 1 cm Urothelial Carcinoma of Renal Pelvis Endoscopic Treatment: Mantu Gupta Nephroureterectomy: Ashok Hemal
15:10-15:20 BCG Failure: Defining and Managing Difficult Patients Michael Cookson
15:20-15:35 Robot Assisted Radical Cystectomy Peter Wiklund
15:35-15:45 RAZOR Trial Dipen Parekh
15:45-15:55 ERAS Protocol Khurshid Guru
15:55-16:55 LIVE OR SEMI-LIVE CASE Moderator: Peter Wiklund Panel: Khurshid Guru, Ketan Badani, John Sfakianos
16:55-17:20 Debate: Open or Robotic Diversion Open: Michael Cookson Robotic: Khurshid Guru
17:20-17:30 Genomic Discoveries in Bladder Cancer John Sfakianos
17:30-17:40 Novel Chemotherapeutics in Bladder Cancaer Matthew Galsky
17:40-17:45 Closing Remarks: Badani Second International Prostate Cancer Symposium and Inaugural World Congress of Robotic Oncology September 6-9, 2017 ● Mount Sinai Hospital ● New York, New York
Please scan and email this form along with the forms below indicating your level of support and any additional advertising and sponsorship opportunities to [email protected]
If you are mailing this form, please send to: World Congress of Robotic Oncology c/o Veritas Meeting Solutions - 2575 Northwest Parkway; Elgin, IL 60124 Company Name (As it should appear on printed material)
Contact Person (Individual to whom all exhibitor information will be forwarded) Title
Street Address
City State Zip
Telephone Fax Email
Product
Special Requests ie. Accessibility, electrical requirements
Badges (Please look at benefits page to determine your complimentary allotment) Representative Name Title Email Address Phone (First, Last)
Payment Information Method of Payment: Check (Payable to Veritas Meeting Solutions) TIN#: 46-3254245 Total Amount of Check: Check Number (if available): Signature (if paying by check):
Credit Card Type: Visa MC AmEx Card Number: Expiration Date: CVV Code: Total to be Charged: Name on Card: Billing Address for Card:
Signature:
Questions- please contact Christina Espiritu at (847)892-7641 or [email protected]