Event, Conference, Trade Show and Sponsorship Request Form

Quintiles is happy to consider all appropriate events, conferences, trade shows and sponsorships. Please fill out all the information below so we may properly evaluate and review. We will notify within two weeks of your request whether or not the request fits our current business needs and if we may have the opportunity to participate.

Fields marked with * are required.

Conference Name:*

Conference Web site:*

Is This Affiliated With an Association?* No Yes

If So, Which Association?

Area of Interest:*

Your Name:*

Your Email Address:*

Is This an International, National or Regional Conference?* International National Regional

Conference Start Date:*

Conference End Date:*

Expected Number of Attendees:*

Attendee Titles:*

List Companies That Attend:*

Expected Number of Exhibitors:*

Companies That Exhibit and/or Sponsor and Type:*

Deadline to Sponsor:*

Is There a Speaking Opportunity Available With the Exhibit?* No Yes

Cost of Exhibit and/or Sponsorship, in U.S. Dollars:*

Does the Sponsorship/Exhibit Cost Include a Pre/Post Show Conference Attendee List?* No Yes

If So, What is Included (i.e. Address, Emails, Titles)?

What Can Quintiles Expect to Achieve by Participating?*

Event Description:*

Other Comments:

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