Lab Directors Virtual Summit 2020 Application

Please complete the below form to apply for the Virtual Summit. Make sure to complete the entire form and then click the blue "Continue" button. Please feel free to call Katie Sieracki at 847-773-0147 with any questions. We look forward to reviewing your application!

Event: Lab Directors Virtual Summit 2020
First Name*
Last Name*
Your Title*
First Name on Badge if different from above
Confirm E-Mail*
Work Address*
State (two-letter abbreviation)*
Work Phone Number*
Cell Number*
Emergency Contact Person AND Phone Number*
To verify that you're a real human and not an automated spambot, please answer the following question:
Independence Day is the Fourth of*
*These fields are required to have a value.

Please tell us about your organization:

Tell us a little about your hospital:

How many beds are in your hospital (or IDN)?

How many tests does your lab perform annually?

What is the annual budget of your lab?

What is currently going well at your lab?

What keeps you up at night regarding your lab?

If you could have dinner with a two or three others in the industry who would you choose?:

If you could join two roundtable discussions with several of your peers, what would the discussion topics be titled?


Do you make the purchasing decisions or make recommendations for purchasing in your lab?

Please tell us about any acquisition plans over the next 6 to 12 months including consumables, testing equipment, software and/or genetic testing:

Please list at least one product or service company who you’d like to learn more about. You can enter as many as five:

Who else from another lab facility would you recommend we reach out to invite to this event?

Which labs do you oversee?

What services do your labs provide?

Are you a member of any GPOs? If so, which one(s)?

Do you have access to a camera on a computer?

I Agree: If I am selected to participate in the Virtual Summit, I agree to be present for all online sessions, meetings, and functions scheduled for the event.

Please enter a short bio (2-5 sentences). If selected to attend, this information will be used in the Summit Guidebook.
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Please only click the "continue" button once. The application will take a moment to process your responses.wid