Superior Media, Meetings & Media, Inc.

If you would be interested in obtaining our services for your upcoming event, please complete the questionnaire below and click the submit button. We will contact you within 2 business days with a preliminary quote. Please let us know your preferred choice for our response.

Contact Information

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Agency/Company: *

Point of Contact: *

Email: *

Phone: *

Fax:

Contact you via: Phone Email Fax

Event Details

Type of Event:

Name of Event:

Dates of Event:

Length of Event:

Preferred City:

State:

Event attendees: Approximate number of event attendees.

Please check each service required: Site Selection Negotiations of contracts / hotel, catering, entertainment, audio/visual, etc.

approximate number of attendees for General Session number of breakout rooms number of Breakfasts number of Lunches number of Dinners number of Morning Breaks number of Afternoon Breaks Audio Visual requirements:

Secure room blocks Meeting Schedule and coordination Exhibit/Trade Show coordination Obtain approval from local Fire Marshall for Exhibit/Trade Show Exhibit/Trade Show procurement Obtain Corporate Support through grants and Contributions Secure Faculty and Moderators Secure Faculty Information (disclosure statements, etc.) for printed materials Budget planning Staffing of Committees Registration Database — web and hardcopy Faculty Database — web and hardcopy Arrange Faculty Travel/Lodging

estimated number of faculty members number air travel number ground transportation number of hotel rooms needed Other:

Faculty honorariums, reimbursements, etc. Promote meeting/event Collect, process and track registration fees Arrange Travel/Lodging for attendees

estimated number of attendees number air travel number ground transportation number of hotel rooms needed Other:

Staff Registration Desk Negotiate and Obtain entertainment Obtain necessary info from faculty to meet CME/CEU requirements Obtain necessary info from sponsors to meet CME/CEU requirements Obtain CME/CEU credits from accredited organizations Post-meeting follow-up with faculty, CME/CEU providers, sponsors Post-meeting reports – minutes, financial, evaluation analysis Process meeting evaluation data Maintain attendee lists Staff “Board of Director” / “Executive Committee” / “teleconference” meetings Produce Agenda and Minutes from all meetings Design, develop, host and maintain Web site Graphic Design, layout and printing of:

Syllabus Programs Invitations/announcements Evaluations Badges Tickets Other:

Additional comments or needs:

Please click the “submit” button to send your completed questionnaire.