2021 Level Sponsorships Form For more information and full descriptions of exhibit enhancement & level sponsorship opportunities, click here for the Exhibitor & Sponsor Prospectus. Company Name*Company Website* Company Twitter HandleAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Name* First Last Contact Email* Contact PhoneLevel Sponsorship OptionsAll Level Sponsorships Include: Recognition as a level sponsor on meeting platform & website Exhibit booth/listing Banner ad on meeting platform Opportunity to distribute survey(s) to IPEG members within 12 months of IPEG 2021 Annual Meeting (number of surveys varies across sponsorship level) Access to non-demographic analytics from IPEG 2021 Annual Meeting Registration(s) to IPEG 2021 Annual Meeting (number of registrations varies across level sponsorships) Product NameDiamond Level Sponsorship-$25,000Platinum Level Sponsorship-$10,000Gold Level Sponsorship-$5,000Silver Level Sponsorship-$2,500Level Sponsorship OptionsNoneDiamond Level Sponsorship-$25,000Platinum Level Sponsorship-$10,000Gold Level Sponsorship-$5,000Silver Level Sponsorship-$2,500Institutional SponsorshipsInstitutional Sponsorship Price: $1,000.00 Institutional SponsorshipNoneInstitutional SponsorshipInstitutional SponsorshipPlease enter a number from 1 to 1.Institutional Sponsorships Include: Recognition as an Institutional Sponsor on meeting platform and website Exhibit Booth/Listing Job Listings on meeting platform/app Total $0.00 Please note: All Institutional & Level Sponsorship payments must be made via check. Please make checks out to the International Pediatric Endosurgery Group and mail to: Attn: IPEG Development Manager International Pediatric Endosurgery Group 11300 W. Olympic Blvd, Suite 600 Los Angeles, CA 90064 For more information on alternative payment options, please contact IPEG Development Manager, Paula Hoffman Kupiec at [email protected]