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ISPOR Latin America 2019 Affiliate Meeting Request

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* 1. Please complete billing/contact information below

Name *

Company *

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address *

Phone Number *

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* 2. The Host Company / Organization MUST be participating as one or more of the following. Check all that apply

Exhibitor

Sponsor

Symposia Host

None of the above

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* 3. Date(s) of requested meeting

Thursday 12 September

Friday 13 September

Saturday 14 September

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* 4. Please list the specific meeting room times

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* 5. Description of Meeting

Client Meetings

Internal Meetings

Other (please specify)

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* 6. Expected Number Attending

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* 7. Additional Comments

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* 8. Are you interested in affiliate meeting room catering?

Yes

No

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* 9. Are you interested in affiliate meeting room AV?

Yes

No

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* 10. Meeting Rooms are subject to availability and are reserved for exhibitors, sponsors and symposia hosts. I acknowledge that I have read and agree with the guidelines. Please enter your full name.