Event Lab Registration Form

Event Title *

Event Description *

Please describe: (1) the procedure to be performed, (2) the purpose of the event (such as sale training , R&D, resident/fellow training, meeting), and (3) your client or trainees

First Name *

Last Name *

Email *

Phone *

Event Date / Start Time *

Please let us know in the event description if the event is multiple days. If you are unsure of your date, let us know in the field below

Potential Dates

Time Preference *

Morning (8am-12pm)
Afternoon (12pm-4pm)
Evening (4pm-8pm)
Full Day

Will your team need more than 2 hours for event set-up?

Please check ‘yes’ if you need 3+ hours the day before or day of event to set up

Yes
No

Location *

Fairfax, VA
Baltimore, MD

Company Name *

Company Division *

Accounts Payable: First & Last Name *

Accounts Payable: Email Address *

Are you authorized to approve and sign estimates on behalf of the company? *

Yes
No

If no, please provide the Authorized Representative’s Name and Email Address *

Number of Attendees *

Event Type *

Conference/Meeting Only
Bioskills Lab and Meeting Space
Bioskill Lab Only (no meeting space)
Other

If Other, Explain *

Do you need catering?

Conference/Meeting Only

Yes
No

Please provide per person budget and menu details

Please let us know if you would like to set up a call to discuss catering needs

Number of Stations Required *

Is Premier Medical managing specimen acquisition? *

Bioskills Lab Details

Yes
No

Specimens Details

Do you need videography?

Yes
No

Do you need Premier Medical to provide additional equipment? *

Yes
No

Please select the equipment you request Premier Medical to supply

Please select all that apply:

Additional details or requests

How did you hear about us? *

Social media, Google search, client referral, repeat client, etc.

Will this event require inbound shipments? *

Yes
No

*

I certify that my team will handle all company shipments*