Tradeshow / Event Registration Request

Event Information & Registration Details

Question Title

* Your Name:

Question Title

* 1. What is the name of this event?

Acronym:

Full Name:

Question Title

* 2. Has your manager provided approval to attend this event?

Yes

Question Title

* Is there a specific document or form needed for registration? If so, please upload here:

Acceptable file types: PDF, DOC, PNG, JPG, JPEG, GIF

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

Question Title

* If there is an additional document or form that's important, please upload here:

Acceptable file types: PDF, DOC, PNG, JPG, JPEG, GIF

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

Question Title

* 3. Who will be attending this event from EWL?

Please list ALL employees going (first & last names):

Question Title

* 4. When does this event take place?

Start Date

Date

End Date

Date

Question Title

* 5. Where will the event be held?

City/Town

State/Province

Question Title

* 6. What is the expected number of attendees at this event?

Question Title

* 7. How should this event be classified? (based on the host organization and the PRIMARY attendees/audience, ie: doctors, NCMs, adjusters, etc. - NOT based on the EWL employees going)

Payor

Medical

Mixed (equal number of Payor & Medical attendees)

Veteran Service Organization

Question Title

* 8. What type of attendance will this be?

Exhibitor / Sponsor

Attendee Only

Speaker Only

Speaker & Exhibitor / Sponsor

Question Title

* 9. What type of event is this based on the following descriptions? (NOT based on what the event itself is called)

National Convention: multi-day, national organization, national audience, large booth size (10x10 or 10x20), involves furniture rentals, etc. (ie: WCI, PAINWEEK)

Regional Conference: 1-3 days, regional organization / audience, standard booth size (sometimes 10x10, but rare)

One-Day Seminar: local event, 1/2 day to full day, may include table for display, typically lower registration costs ($250-$1200)

Society Sponsor: recurring local events, attached to membership or sponsorship level (ie: PWC, ITLA, WCLA events, lunch & learns), may or may not have small table display

Networking Sponsor: local event, mostly social, no table display (ie: happy hour, hosted dinner, 5K run, golf tournament, typically nominal cost ($100-$500) or attendance is included with sponsorship level)

Question Title

* 10. Requested Booth Location / Number - please list top 3 choices (if none are requested, booth selection will be chosen at random):

Question Title

* 11. What is the Registration Cost for the event?

Registration / Sponsorship Cost (please note level if applicable, ie: Gold/ Silver Sponsor):

Additional Attendee Cost (per attendee - if applicable):

Question Title

* 12. Who is the Target Audience for the event?

Health Care Providers

Insurers / Payors

Adjusters

Employers

Nurse Case Manager

Ortho MDs

Physical Therapists

Nurse Practitioners

Risk Managers

Attorneys

Physicians (non-ortho)

Other (please specify below)

Other (please specify)