INR Mobile Event Request Form EVENT DETAILSDate Request Submitted* Date Format: MM slash DD slash YYYY Requested By* First Last Event Start Date* Date Format: MM slash DD slash YYYY Event End 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*Point of Contact (On-Site)* First Last MEETING SPECIFICATIONS Food & BeveragePlease select your food & beverage needs* Beverage Station (Coffee, Tea, Water, Soda) Snacks (Granola Bars, Trail Mix, Chips, Pretzels, etc.) Hors d’oeuvres (PM Event Only) House Beer & Wine (PM Event Only) Note: The Meeting Coordinator will make final selections to ensure Compliance guidelines are met.Known Food Allergies/Restrictions* Room Set Meeting Coordinator will utilize the standard open floor plan for Mobile Events to accommodate flow. ExcelsiusGPS® will be stationed with a table adjacent to use for demo purposes. Special requests can be discussed directly with assigned Meeting Coordinator. 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.