Gynesonics Rep Name(Required) What is the start date of your event?(Required) If you don't have a specific date, please enter XX.Create a title for your event.(Required) What type of event are you requesting?(Required) Local/Regional Sponsorships In-Person HCP Speaker Event (5 or more HCP attendees) Virtual HCP Speaker Event (5 or more HCP attendees) In-Person Peer-to-Peer Meeting (1 or 2 HCP attendees) Virtual Peer-to-Peer Meeting (1 or 2 HCP attendees) In-Person Patient Education Event Virtual Patient Education Event Event location: City, State Describe your event in detail. Include the business purpose.(Required)Which customers or accounts may be engaged by this event?(Required)Upload a flyer or conference brochure if available. Drop files here or Select files Max. file size: 40 MB. Upload the proposal, invoice or sponsorship agreement if available. Drop files here or Select files Max. file size: 40 MB. What is the venue for this event? Conference Center Hospital or Physician's Office Meeting Room (Hotel) Restaurant Virtual Other What is the name of the venue? Not required for virtual events.Is this a private room? Yes No Entertainment is NOT allowed at a sponsored event. Meals or refreshments may be provided if they are reasonable and do not exceed $50 (USD) for breakfast or lunch, $150 for dinner including tax and tip. Will a meal or refreshments be provided at this event?(Required)YesNoI don't know yetIf you have a proposal/contract in progress with a venue, upload here: Drop files here or Select files Max. file size: 40 MB. Approximately how many attendees are expected?(Required) Will you need an invitation or flyer?(Required)YesNoI don't know yetIs an HCP consultant needed to speak at this event?(Required)NoYes. I do not have a presenter in mind.Yes I would like to recommend an HCP presenter.Do NOT discuss any speaking engagement with an HCP unless approved by the Professional Education department.Who is the HCP Consultant you would like to recommend? REMINDER: Do NOT discuss any speaking engagement with an HCP consultant unless approved by the Professional Education department.Are there characteristics of an HCP Consultant that you would like to request? EXAMPLE: Type of institution, gender, race, site of service, etc. Will a slide presentation be needed?(Required)NoYes, I will need a master HCP presentationYes, the speaker intends to create their own presentationREMINDER: ALL slides must be approved by the Professional Education department in advance of the presentation. What is the total funding amount requested for this event?(Required) Do not include any HCP speaker consulting or travel expenses. If you don't have a fixed funding request, please enter "To be determined" or your best estimate.FRM 04858-022 Rev. D
