5/1/2014
Department of CME
Staten Island University Hospital
475 Seaview Avenue
Staten Island, NY 10305
Your company is invited to participate as an exhibitor at our continuing medical education activity titled the
New York Medical Imaging Informatics Symposium 2014. The program will take place Sept 18, 2014 at the
New York Marriott Marquis.
There are 2 ways for vendors to participate: providing 1) a commercial support grant and 2) purchasing
technical exhibit space. Given the success of the past 4 years, the addition of even more high profile
speakers and an aggressive marketing plan, we expect strong attendance in 2014, about 200 participants. At
the same time, we do not want costs to exceed what vendors can afford to spend on this event. It is with
these factors in mind that we set the price list for 2014.
Commercial Support



Platinum - $10,000
Gold - $7,500
Silver - $5,000
Large signs will be placed outside the technical exhibit and lecture halls acknowledging the commercial
supporters with their respective designations, and the same acknowledgement will be printed in the course
syllabus. To provide a commercial support grant, please use the form provided at the end of this document.
Please note that a commercial support grant does not include exhibit space. That must be purchased
separately.
NEW FOR 2014: Higher level supporters wil be listed in a larger font on the signs, and corporate logos will be
placed on the signs. Please note that corporate logos can not be printed in the course syllabus.
Exhibit Space

Single booth up to 10 feet wide - $3,500
Exhibitors will receive:



Access to exhibit space for two company employees
One draped 6-ft. long table per booth space
One copy of course material
Exhibit space will be assigned on a first-come, first-served basis, and early submission of payment is highly
recommended to secure your space. To reserve exhibit space, please see the floor diagrams on the following
pages and use the form provided at the end of this document.
Staten Island University Hospital is accredited by the Medical Society of the State of New York to provide
continuing medical education for physicians, and expects exhibitors to comply with the ACCME’s Standards
for Commercial Support sm.
NEW FOR 2014: In the past, participants were given the option to opt out of sharing their contact information
with the vendors. This is no longer being presented as an option. Rather, the full list of participants, with
their contact info, will be provided to all commercial supporters and technical exhibitors.
If you have any questions or would like additional information, please call the CME Office (718) 226-8386.
Sincerely,
Susan Lenzo
Coordinator
Continuing Medical Education
slenzo@siuh.edu
We have the good fortune again this year of using the 5th floor of the Marriott, albeit on the other side. The
5th floor is newly renovated with gorgeous LCD lighting and modern carpeting and furnishings. The technical
exhibits, where all food will be served, will be in Salons 3 and 4 of the West Side Ballroom, and the lectures
will be in the Lyceum Complex.
Picture of West Side Ballroom:
There will be 20 booth spaces in the main exhibit hall, with more placed out in the hallway. The vendor booth spaces are marked in orange and are
approximately 10 feet wide by up to 6 feet deep. There will be tables set up in the middle for attendees to sit down and eat. To reserve a space, please
use the form below.
12
13
14
15
16
17
18
19
20
10
9
8
7
6
5
4
3
2
1
Buffet
11
STATEN ISLAND UNIVERSITY HOSPITAL
DEPARTMENT OF CONTINUING MEDICAL EDUCATION
EXHIBITOR FORM
Thank you for your support of this program. As an exhibitor you will be provided with a draped 6-ft. long table
per booth space and a copy of the course syllabus. If you have special logistical needs for your display or need
electricity, please communicate directly with Marriott and use their forms provided on the NYMIIS.com
website. Please complete this form and return it with payment as directed below.
TITLE OF PROGRAM:
New York Medical Imaging Informatics Symposium 2014
LOCATION:
New York Marriott Marquis, 1535 Broadway, New York, NY 10036
DATE:
September 18, 2014
EXHIBITING COMPANY:
ADDRESS:
CITY, STATE, ZIP:
CONTACT:
TELEPHONE:
FAX:
EMAIL:
EXHIBITOR FEE: $
PREFERRED BOOTH SPACE NUMBER(S):
COMPANY EMPLOYEES WHO WILL BE ATTENDING THE PROGRAM: (maximum of 2)
1. ________________________________ 2. _______________________________
EXHIBIT TERMS: Staten Island University Hospital assumes no responsibility for the safety of exhibitor
property, company employees, officers, or agents from theft, damage by fire, accident, or other causes.
Exhibitors must make provisions for safeguarding goods, materials, equipment, and display at all times, and
exhibitors are liable for any damage caused to the building, floor, walls, or to other exhibitor’s property.
ACCEPTANCE: By signing below, Exhibitor has read, understands and agrees to abide by all the exhibit rules
and regulations set forth above and as provided in the Accreditation Council for Continuing Medical Education
Standards for Commercial Supportsm attached hereto.
AUTHORIZED SIGNATURE: _____________________
DATE: _________________
Please make check payable to: SIUH CME Fund and mail to the attention of: Susan Lenzo, Staten Island
University Hospital, Department of Continuing Medical Education, 475 Seaview Avenue, Staten Island, New
York 10305.
Staten Island University Hospital
Written Agreement For Commercial Support
Staten Island University Hospital is committed to presenting CME activities that promote improvements or quality
in healthcare and are independent of the control of commercial interests. As part of this commitment, SIUH has
outlined in this written agreement the terms, conditions, and purposes of commercial support for its CME
activities. Commercial Support is defined as financial, or in-kind, contributions given by a commercial interest i,
which is used to pay all or part of the costs of a CME activity.
Title of CME Activity
New York Medical Imaging Informatics Symposium 2014
Activity Location
New York Marriott Marquis, 1535 Broadway,
New York, NY 10036
Activity Date
9/18/2014
Name of Commercial Interest
Amount of Educational Grant
(direct or in-kind)
Terms, Conditions, and Purposes
Independence
1.
2.
This activity is for scientific and educational purposes only and will not promote any specific proprietary business interest of
the Commercial Interest.
The Accredited Provider is responsible for all decisions regarding the identification of educational needs, determination of
educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a
position to control the content of the CME, selection of education methods, and the evaluation of the activity.
Appropriate Use of Commercial Support
3.
The Accredited Provider will make all decisions regarding the disposition and disbursement of the funds from the
4.
5.
6.
Commercial Interest.
The Commercial Interest will not require the Accredited Provider to accept advice or services concerning teachers, authors, or
participants or other education matters, including content, as conditions of receiving this grant.
All commercial support associated with this activity will be given with the full knowledge and approval of the Accredited
Provider. No other payments shall be given to the director of the activity, planning committee members, teachers or authors,
joint sponsor, or any others involved with the supported activity.
The Accredited Provider will upon request, furnish the Commercial Interest documentation detailing the receipt and
expenditure of the commercial support.
Commercial Promotion
7.
Product-promotion material or product-specific advertisement of any type is prohibited in or during the CME activity. The
8.
juxtaposition of editorial and advertising material on the same products or subjects is not allowed. Live or enduring
promotional activities must be kept separate from the CME activity. Promotional materials cannot be displayed or distributed
in the education space immediately before, during or after a CME activity. Commercial Interests may not engage in sales or
promotional activities while in the space or place of the CME activity.
The Commercial Interest may not be the agent providing the CME activity to the learners.
Disclosure
9.
The Accredited Provider will ensure that the source of support from the Commercial Interest, either direct or “in-kind,” is
disclosed to the participants, in program brochures, syllabi, and other program materials, and at the time of the activity. This
disclosure will not include the use of a trade name or a product-group message. The acknowledgment of commercial support
may state the name, mission, and clinical involvement of the company or institution and may include corporate logos and
slogans, if they are not product promotional in nature.
The ACCME defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or
used on, patients. (Effective 8/07) MSSNY does not consider providers of clinical service directly to patients to be commercial interests. Within the
context of this definition and limitation, MSSNY considers the following types of organizations to be eligible for accreditation and free to control the
content of CME:
501-C Non-profit organizations, Government organizations, Non-health care related companies, Liability insurance providers, Health insurance providers,
Group medical practices, For-profit hospitals, rehabilitation centers and nursing homes.
Page 1 of 2
The Commercial Supporter and Staten Island University Hospital agree to abide by all requirements of the Accreditation
Council for Continuing Medical Education (ACCME) Standards for Commercial Supportsm (available at ww.ACCME.org).
Accredited Provider
Name
Tax ID Number
Contact Person
Phone
Fax
Email
Address
Staten Island University Hospital
Grant Payable to: SIUH CME FUND
11-2868878
Susan Lenzo
718-226-8386
718-226-8352
slenzo@siuh.edu
Staten Island University Hospital
CME Department
475 Seaview Avenue
Staten Island, NY 10305
Commercial Interest
Name
Tax ID Number
Contact Person
Phone
Fax
Email
Address
Agreed by Authorized Representatives
Commercial Interest
Signature and Date
Print Name
Title
Accredited Provider
_______________________________________
Signature and Date
_______________________________________
Print Name
_______________________________________
Title
Page 2 of 2