Industry Hosted Education and Events Form Contact InformationCompany Name* Contact Name* First Last Contact Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Industry Education Options* Industry Sponsored Learning Center Stations Industry Suites Industry Satellite Symposia Click any option above to read more about details and pricing.INDUSTRY SPONSORED LEARING CENTER STATIONS- $5,000 The AHNS Learning Center will be comprised of stations designed, developed and executed by our industry partners. This is your opportunity to deepen the learning experience for attendees specific to your technology or service. these stations will feature content, curriculum and activities determined by the host company. Stations will be located in the exhibit hall immediately adjacent to the poster session. The AHNS will provide the appropriate space and electricity at the Learning Center. Each participating company will be responsible for staffing their station and for all equipment, supplies and/or specimens (specimens must be inanimate). The AHNS will market this opportunity to attendees on the AHNS website, pre-meeting communications, on the meeting app and on-site with signage. Industry will also be able to market your station to attendees (marketing materials subject to AHNS approval) and make appointments with attendees to visit your station during hours the Learning Center is open. This is a non-CME activity. INDUSTRY SUITES-$5,000 The AHNS will provide a limited number of Industry Suites in the back of the exhibit hall to allow for private meetings with attendees, AHNS leaders and company staff. Each 10 x 10 suite will be hard-walled with entry through a locked door (key provided). A table, chairs and trash can will be provided. INDUSTRY SPONSORED SATELLITE SYMPOSIA $20,000 There will be a total of nine opportunities to host a Satellite Symposia as follows: Thursday, July 22, 2021 6:30 am – 8:00 am; 6:45 pm – 8:15 pm Friday, July 23, 2021 6:00 am – 7:30 am; 6:30 pm – 8:00 pm Saturday, July 24, 2021 5:30 pm – 8:00 pm The fee for hosting a symposium is $20,000. Standard room set and AV is included in the fee. Sponsor will be responsible for any F & B and any additional av. A limited number of companies will have the opportunity to present an educational event of their choosing which may include, for example, a panel discussion or an invited speaker. Satellite symposia can be CME or non-CME events. Rooms for this event will be assigned on a first-come first-served basis. Symposia support will be acknowledged on the AHNS website, on the meeting app and on-site with event signage. (Please complete satellite symposia application and return with your support confirmation.) The symposia will be promoted in advance marketing materials for the meeting and via emails to attendees. On-site signage will be produced to further promote the event at the meeting. Other marketing opportunities will be provided. This is a great opportunity to have an exclusive audience with AHNS attendees focused on education directly related to your goals. If your company is interested in learning more about this opportunity, please contact Colleen Elkins at the AHNS office at 310-437-0559, ext. 114 or, via email: firstname.lastname@example.orgPlease drag the dates in order of most preferred to least preferred.Thursday, July 22- 6:30am-8:00amThursday, July 22- 6:45pm- 8:15pmFriday, July 23- 6:00am-7:30amFriday, July 23-6:30pm-8:00pmSaturday July 24- 5:30pm-8:00pmPlease note: Time slots are first come, first served. You are not guaranteed to receive your preferred choice.Total $0.00 Please note: all payments must be made by check. Please make checks out to the American Head and Neck Cancer Cociety and mail to: AHNS 11300 W. Olympic Blvd, Suite 600 Los Angeles, CA 90064NameThis field is for validation purposes and should be left unchanged.