AAPM&R 2024 Function Request Form

Fees apply to all meetings requesting access to the AAPM&R attendees. By paying this fee your event will be an approved AAPM&R event and you will be given access to market this event to attendees during the Annual Assembly. AAPM&R reserves the right to limit promotion of the event during the meeting if a fee has not been paid or the event has not been approved by AAPM&R. Fees are lower for companies belonging to the Industry Relations Council (IRC).

Submission deadline date: October 3, 2024

First Name *

Last Name *

Company *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Is your Company a participant in the Industry Relations Council (IRC)? *

Yes

No

Meeting Logistics

Title of Meeting *

Will AAPM&R Physician(s) be in attendance?

Yes

No No

Who will be your primary audience? *

Internal Staff

AA attendees

Other: please specify Other: please specify

Meeting Location *

AAPMR Headquarter Hotel

Offsite

Please explain your offsite event details. *

Purpose of Meeting: *

Advisory Board

Social Event

Internal Staff Meeting

Other Other

Estimated attendance (IRC Member Social Event) *

Up to 50 attendees

51- 75 attendees

Estimated attendance (IRC Member Advisory Board) *

Up to 10 attendees

10-20 attendees

Estimated attendance (Non- IRC Advisory Board) *

Up to 10 attendees

10-20 attendees

Estimated attendance (Non- IRC Social Event) *

Up to 50 attendees

51-75 attendees

Non IRC Offsite Event *

Up to 50 attendees

51+ attendees

Additional Marketing Opportunities

AAPM&R Attendee Mailing list - $1,000

Hotel Door Drop - $8,000

Current Total:

$0.00

Proposed Meeting Start Time: *

Proposed Meeting End time: *

Proposed Speaker: *

Proposed Meeting Date: *

Room Setup: *

Please supply any other relevant information about this meeting:

For more information on how to become an IRC member please go to the following link:

http://www.aapmr.org/about-aapm-r/corporate-support/industry-relations-council

Thank you for completing the information. AAPM&R will review the information and respond to you within 10 business days. We look forward to a successful meeting

If you have any questions please contact:

Patricia Swift, CMP

Conventus Media

pswift@conventusmedia.com

(703) 581 9602