Download the Industry Prospectus - TCT

Application to Conduct aPresentation Theater ProgramTCT25Application Fee: $30,000Deadline: June 7, 2013Applicant InformationProgram TitleProgram DescriptionCompany (as should appear in print) Contact Name TitleCompany Address City StateZip/Postal CodeCountryTelephone (country code/city code/number)Fax (country code/city code/number)E-mail (mandatory)Preferred Participation Day and Time*TimeApplication Feeq Tuesday, October 29, 2013q Wednesday, October 30, 2013q Thursday, October 31, 2013* Day assignment is at the discretion of CRF.All preferences will be considered.q 12:15 pm-1:15 pm..............................................................................................$30,000Will this program be accredited?q Yes q NoIf yes, applications will be accepted only if submitted by a medical education provider accredited by the ACCME.PaymentPayment in full is due with application.Please make check payable to:Cardiovascular Research Foundation – TCT 2013(US funds in dollars drawn on a US bank)Mail payment to:Tricia RawhProgram Project ManagerCardiovascular Research Foundationc/o JP Morgan ChasePO Box 30730New York, NY 10087Tel: 646-434-4381Fax: 646-434-4713E-mail: trawh@crf.orgAuthorizationThe company submitting this application understands that this application is acontract when duly executed by the authorized company representative. The companyagrees to comply with the guidelines for conducting a satellite program at TCT 2013,understanding the costs associated with conducting a satellite program and has readand understands the cancellation policy outlined on page 25.Authorized SignatureDateName (please print)Title33