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Affiliate Space Request Form

November 2-6, 2012

Bally's Las Vegas
Las Vegas, Nevada

DEADLINE: AUGUST 14, 2012

Please complete a separate request form for each function room required.
*	Committee/Company/Group
*	Contact Name
*	Address
	Address 2
*	City
*	State
*	Zip
	Country
	Phone
*	Email
	Name of Event
*	Preferred Date of Event
*	Preferred Starting Time of Event
*	Preferred Ending Time of Event
	Number of Expected Guests
	Expected Attendee Type	61st Annual Scientific Meeting Attendees Company Personnel Only Other
	If other, please Specify
	Event will be held at the ASC contracted hotel
	Other Location
	Food and Beverage Required
	Room Set-Up Required
	Audiovisual Required
The ASC has contracted with Visual Aids Electronics as our preferred AudioVisual provider. If you require audiovisual, contact information for VAE will be forwarded to you.
The ASC must review and approve ANY event affecting ASC Meeting Attendees during the inclusive dates of the Annual Scientific Meeting before promotion and implementation of the event can occur, whether it is being held at ASC contracted facilities or otherwise.