Request Approval to Attend Form

Request Approval to Attend Form

To expedite your request, please fill out the form completely.
Name*

First NameMiddleLast Name / Family Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country*
Email address *
Phone Number:*
Credentials, job title, etc. *
(ex: MD, RN, PA, CST, VP)
What is your reason/purpose for attending the meeting?*
Please upload documentation indicating your professional status: See examples below:
- RN, NP, PA, CST, PT, etc…Required: license/certification #, signed and dated letter of sponsorship from your employing physician or institution and NPI #
- Office Staff to include office manager, practice admin, office asst. – Required: dated letter on letterhead from sponsoring orthopaedic explaining your role in the practice and reason for attending
- Researchers, CEO’s, Marketers, Director level titles, public media personnel – Required: dated letter on letterhead from sponsoring orthopaedic explaining your role in the practice and reason for attending and business card
- Industry Research & Development – Required: Signed and currently dated letter of sponsorship from your exhibiting company
Upload proof of credential*

Upload Files Here

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