DEADLINE DATE: SEPTEMBER 28, 2012

ASN KIDNEY WEEK

PROMOTIONAL ITEMS DISTRIBUTION REQUEST FORM

San Diego Convention Center, San Diego, CA
November 1 – 3, 2012

this is an electronic form – please complete your information directly on this form

By filling out this form electronically, ASN assumes that you have read and will comply with the guidelines and rules and regulations pertaining to promotional items distribution in the Exhibitor Prospectus.

Please complete and email this form to .

Company Name: Booth No.:

Contact Name: Email/Phone No:

Signature (required if faxing form):

I am an employee/agent of the exhibiting company and acknowledge the above information. I understand ASN will not review forms after these dates and that ASN is the sole judge of what is appropriate for a promotion at ASN Kidney Week 2012.

Approved Items: The following items are generally approved and do not need written approval for distribution at ASN Kidney Week 2012:

Bandages

Calculators

Calendars

Clocks

Flashlights

Ink Pens

Key Chains

Letter Openers

Luggage Tags

Mugs/Coasters

Note Pads/Post-it

Notes

Printed Company

Materials

Staplers

Distributed items must feature the name and/or logo of the exhibiting company.

Disapproved Items: The following items will not be approved for distribution:

Adhesive badge stickers

Balloons

Bumper Stickers

City Souvenirs

Internet Access for Attendees

Games/Toys/Stuffed Animals

Sports Paraphernalia

These lists are not all inclusive. Any item not listed as approved on this list above may not be distributed without written permission from ASN Exhibit Management. All giveaways must be in compliance with the Advanced Medical Technology Association (AdvaMed) Code of Ethics on Interaction with Healthcare Professionals; the American Medical Association (AMA) Gifts to Physicians from Industry Ethical Opinion 8.0611; The Pharmaceutical Research and Manufacturers Association (PhRMA) Code on Interactions with Healthcare Professionals, and other ethical guidelines and standards that describe the appropriate relationships between physicians and industry. ASN refers exhibitors to these ethical guidelines and expects all exhibitors at Kidney Week 2012 to be in compliance.

All requests to distribute promotional items that are not specifically listed above as approved items must be submitted in writing for approval to ASN exhibit management. Requests must be received by September 28, 2012. Please list and describe your items in the space provided below:

Please email this form to , or fax to at 202-367-2146. If you have any questions or need additional information please call 202-367-2412.