ADURS Corporate Attendee ListServ Form

NOTICE: This form is for our ListServ for symposium notifications ONLY. Submitting this form doesn't grant automatic access to our symposiums nor does it secure a place on our annual Commitment Form waitlist.

ADURS is not responsible for communication failures due to firewall blocking, outdated contact information, and all factors outside of our control.

Please complete the following listserv form if your Company is interested in becoming a Corporate Attendee at our annual ADURS Symposiums OR if you need to update your current contact information.
Use your WORK email so we can verify current employment status.
You are responsible for the accuracy of your information.

Please Note: ADURS allows up to eleven (11) companies - ten (10) renewable spots and one (1) wildcard spot, subject to change - to send up to four (4) attendees each to the annual Symposium. Companies attending from the past year will be given first right of refusal for the subsequent year. Registrations from individual industry representatives not employed with one of the approved ten corporations will not be accepted.

Question Title

* 1. New Inquiry or Updating Contact Information?

New Inquiry

Updating Contact Information

Please remove me from listserv

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* 2. Company Name

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* 3. Please enter your contact information. (Lines with * indicates required)

First and Last Name *

Designation , if applicable (e.g. PharmD, MBA, MS, etc.)

Job Title *

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* 4. Contact information continued... (Lines with * indicates required)

Email Address* *

Work Phone Number* *

Cell Phone Number (opt.)

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* 5. Are you the designated event planner/director for your company?

Yes

No (please specify name & email address of person in charge)