Industry Symposium Application

AATS GRAHAM FOUNDATION INDUSTRY-SUPPORTED
SYMPOSIUM APPLICATION
April 25-29, 2015 – Seattle, WA
Applications received after February 23rd will be accepted on a space available basis.
Industry Symposia Agreement Form
_________________________________________________________________________________________________
Exact Title of Symposium
Name of Accrediting Organization (if accredited)
_________________________________________________________________________________________________
Sponsoring Company Name
Contact Name
_________________________________________________________________________________________________
Address
City
State
Zip
Country
_________________________________________________________________________________________________
Phone
Fax
Email
Brief Description of Meeting:
Target Audience: ______________________________
Expected Attendance: ________
Friday, April 24, 2015
20 – 49 pp
1– 2 hours
$7,500* **$1,000 per additional hour
Saturday, April 25, 2015
50+people
1 – 2 hours
$15,000
Sunday, April 26, 2015
Monday, April 27, 2015
Tuesday, April 28, 2015
Price: $________ + additional hours______= Total Price $_________
Wednesday, April 29, 2015
ROOM SET:
 Banquet (rounds)  Podium
 Classroom
 Reception
 Conference
 Theater
 Hollow Square  U-shape
 Head table # ppl____
FUNCTION TYPE (check only one)
 Breakfast  Lunch  Dinner
 Reception (Friday or Wednesday only)
REQUESTED TIME:
Start: _____ am/pm
Finish: ______ am/pm
* must be by invitation only, pre- registration list not included
**$1,000 per each additional hour for functions over 2 hours
Once space has been assigned and confirmed by AATS you will be put in direct contact with a catering representative.
Catering, special set fees, AV, electrical/telecommunications and labor are not included in the fee. Each sponsor is
responsible for all charges to the facility. For any cancellations received before March 20th, company will be liable for a
50% processing fee. For any cancellations received after March 20th, refunds will not be given.
PAYMENT INFORMATION: All checks must be payable to the AATS Graham Foundation
Check amount enclosed: $____________
FEE DUE: $___________
CREDIT CARD 


Amount to be charged: $___________
______________________________________________
Credit Card Number
______________________________________________
Name as it appears on credit card
_____________
Expiration Date
________________
Security Code
____________________________________________
Cardholder’s Signature
 Please check if credit card billing address is same as contact information at the top of the form.
 If billing address is different please enter below.
_________________________________________________________
Company Name
__________________________________________________________
Street Address
____________________________________________________
City/State/Postal Code /Country
Complete and return to: AATS Graham Foundation
500 Cummings Center, Suite 4550,
Beverly, MA 01915 USA
978-927-8330 Fax: 978-524-0461 [email protected]