Exhibitor Sponsor Contract

Please enter all required information as well as your payment information before clicking submit. If you wish to pay your exhibit fee by check, please download the PDF version of this contract. All fields marked with an * must be completed or your submission will be rejected.

Company Name *

Contact Name & Title *

Company Mailing Address *

City, State Zip *

Telephone Number *

Email *

Brief Product & Service Description *
(Maximum characters: 2000)
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For each product or service you intend to display at the ICSUS 84th Annual Surgical Update
please list the FDA status.

Include name of product(s) in the field below and whether product is
Approved, Investigational, Not Approved or N/A if FDA status is not applicable.

(Maximum characters: 2000)
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Select an Exhibit option from the list below...

Table Top Exhibit ($2,500)

Standard Virtual Exhibit ($1,250)

Enhanced Virtual Exhibit ($1,750)

Clear Selection

If providing other support please enter dollar amount here and provide description of what you are supporting in the next field.

Support Description
(Maximum characters: 2000)
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VIRTUAL WEB SITE
Please provide the weblink to your company’s website that you would like posted to the
84th Annual Surgical Update Virtual Exhibit Hall.
(Web page content must conform to any applicable ACCME rules for advertising.)
All exhibitors will receive a virtual exhibit even if you are participating in person.

In accordance with the terms of the Exhibit Show published on this website, I hereby accept said terms and conditions for exhibiting as they may be amended from time to time by the Sponsoring Organization, International College of Surgeons - U.S. Section (ICSUS), and as described in detail therein. When submitted and accepted, this completed form represents a binding agreement between the Exhibitor, Exhibitor’s employing company and the Sponsoring Organization.

Entering your name and date below will serve as a digital signature. By doing so you agree to execute this document through such means.

This agreement can only be submitted if paying by credit card. Payment information must be provided before clicking submit or your submission will be rejected.

Signature of authorized representative *

Title *

Date *

Payment Total

Payment Information

Amount to Charge :

Payment Method:

Enter the name on the bank account according to the information shown on your bank statement. The account number and routing number can be copied from the lower left corner of the check.

Bank Name:
Bank Account Holder Name:
Routing Number:
Account Number:
Account Type:

Name on Card:

Card #:

Expires:

CSC (What's this?):

Fields marked with * are required.

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