EmailMe Form - ADA QUALIFYING QUESTIONNAIRE

ADA QUALIFYING QUESTIONNAIRE

Thank you for your interest in exhibiting at an American Diabetes Association meeting.

Your company and products must be sent to a screening committee for approval to exhibit.

Please complete the following questions at your earliest convenience.

Once received, your questionnaire will be sent to the American Diabetes Association for approval. Since your approval to exhibit is pending, do not make any arrangements for participation including travel and hotel until you receive official approval, are assigned space, and have submitted your payment.

If you have any questions, please feel free to contact: Merle Zappan.

Exhibitor Listing
1. Company Name: *
Name *
Title/Role *
Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Phone Number *
Email *
Web Site *
I am interested in:
Scientific Sessions
Clinical Update Conference
Diabetes Technology Meeting
2. Please provide a brief description of the products/services you plan to exhibit: *
3. List Government Approvals received: *
4. List stage of clinical trials, if applicable: *
5. List any ADA Publications in which you currently advertise: *
6. List any professional meetings where you have exhibited this product/service: *
7. Have you submitted your application to exhibit? *
8. Do you plan on selling your product during the show? *
9. Do you plan on taking orders during the show? *
10. If approved as an exhibitor and your product is dietary, please list the name and nutritional value and attach product's nutritional label below. *
Please upload the products nutritional label.

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