INR Education Event Request Form EVENT DETAILSDate Request Submitted* Date Format: MM slash DD slash YYYY Requested By* First Last Event Date* Date Format: MM slash DD slash YYYY Event Start Time*Event End Time*Event Location* City State / Province / Region Preferred Venue Location Please list your top three preferred venue options in order of preference.Venue Option #1*Venue Option #2*Venue Option #3*Total Anticipated Attendees Please outline your total anticipated attendees for each category listed.Surgeons*Sales*GMED* MEETING SPECIFICATIONSEducational Event Agenda Please review and plan to utilize this agenda example: 4:00-5:00pm ExcelsiusGPS Delivery/Set-Up 5:00-7:00pm ExcelsiusGPS Hands-On Demonstration 7:00-8:00pm Surgeon Presentation 8:00-9:00pm Wrap-Up/ExcelsiusGPS Pack-Up Food & BeveragePlease select your food & beverage needs* Heavy Hors d’oeuvres Food Stations Buffet House Beer & Wine Note: The Meeting Coordinator will make final selections to ensure Compliance guidelines are met.Known Food Allergies/Restrictions* Audio Visual Projector, screen, connection capabilities will automatically be ordered for this event. Please plan to bring your own laptop for presentation needs. Will this event require a Wi-Fi connection?*YesNo IMPORTANT INFORMATIONCompliance/Spending Limits Policy In effort to comply with the Globus Medical & AdvaMed Policy – all meals provided to healthcare professionals must be limited to the below spending limits: Amounts listed below are caps on the total spend, including tax and tip. Lunch: $50.00/person Dinner: $125.00/person ($150.00/person for the 10 cities listed below) Chicago, Dallas, Houston, Las Vegas, Los Angeles, Miami, New York, San Diego, San Francisco, Washington D.C. Hotel & Restaurant Contracts/BEOs Only members of the Meetings Team are permitted to sign contracts for event space and BEOs (Banquet Event Orders) confirming Food & Beverage requirements. The Meeting Coordinator/Planner is the only person authorized to charge anything to the master account. If any changes need to be made while the group is on-site and you are not able to get in touch with your Meeting Planner, it is the responsibility of the on-site contact to provide payment for those changes. CONFIRMATIONSPlease confirm you have read and understand all of the policies and event guidelines listed above.*Yes, I have read and understand the information listed aboveNo, I have not read the information listed abovePlease confirm you have Zone Director approval of this event on file.*Yes, I have ZD approval on fileNo, I do not have ZD approval on fileMeetings will not be authorized to move forward with an event request that did not receive Zone Director approval.