ICS US Section Exhibitor Sponsor Contract | International College of Surgeons, US Section

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 below. If you wish to pay by ACH or bank wire transfer, contact ICSUS staff for information. 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 *
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For each product or service you intend to display at the ICSUS 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.

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Select an Exhibit or standard Sponsorship option from the list below...

Standard Table Top Exhibit ($5,000)

Enhanced Table Top Exhibit ($10,000)

Saturday Dinner Sponsor ($2,500)

Saturday Dinner Sponsor ($5,000)

Lunch Sponsor ($5,000)

Breakfast ($2,500)

Coffee Break ($2,500)

Meeting Enhancements Sponsor ($2,500)

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

Support Description
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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.

A convenience fee for credit card use will be added as noted below.

Convenience Fee *

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Signature of authorized representative *

Title *

Date *

Payment Total

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.

Account Type

Checking

Savings

Routing Number

Account Number

Account Holder Type

Business

Personal

Business Name

Account Holder Name

By submitting payment, I am authorizing International College of Surgeons, US Section to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting International College of Surgeons, US Section, or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) the ACH/electronic payment I am authorizing complies with all applicable laws.

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Expiration

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Billing Street

Billing Zip Code

Due Today

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Total Amount Due

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