Equipment Confirmation of Agreement

Please complete the information below and submit to confirm your participation in the Hands on Courses/Learning Center/Mini Med School at the SAGES 2019 Annual Meeting. For any questions please email Ms. Nicole Von Husen at Nicole@sages.org.

The deadline to confirm participation is Friday, February 15, 2019, early confirmation is appreciated.

Company Name*
We agree to*
- provide all the equipment with quantities listed on the SAGES request form provided.
- provide some of the equipment listed on the SAGES request form provided, with specified modifications to quantity or equipment. Please email revised list to nicole@sages.org
Name of person completing this Confirmation Agreement*
Date
MM slash DD slash YYYY
Please provide the name and contact information of your company’s field representative attending the 2019 SAGES Annual meeting. We will provide onsite logistical information to the representative.
On-Site Field Representative Email Mobile Number

Click on the + button on the right hand side of your entry to add the information of additional representatives.

On-Site Field Representative	Email	Mobile Number