Policy Committee Meeting 12.4.23

New OMA Corporate Partner Application (web-based) Questionnaire

Contact Information Company Name

Company Type (choices include: Lifestyle & Behavior, Measurement Device and Metabolic Testing, Nutrition/Supplements, Pharmaceutical, Physical Activity/Exercise, Services, Technology Hardware/Software, Esthetics/Appearance, Other) Address (City, State, Zip Code Website Primary Contact Name Primary Contact Phone Primary Contact E-mail How would you like to partner with the OMA? (Choices include: Exhibits, Advertising, Sponsorships or Other; respondents can multiselect their choices) Does your advertised product or service require FDA approval? (Choices include: Yes, No, or Not Applicable) Has your advertised product or service obtained FDA approval? (Choices include: Yes, No, or Not Applicable) Does your company plan to market human chorionic gonadotropin (HCG)? (Choices include: Yes, No, or Not Applicable) Does your company participate in compounding of pharmaceuticals such as peptides? (Choices include: Yes, No, or Not Applicable) Does your company plan to market a franchise? (Choices include: Yes, No, or Not Applicable) Describe your product or service: (Free text box) Describe how your product or service might help patients with obesity. Please be specific. (Free text box) Upload a recent sample of your company’s marketing materials (e.g. website, brochures, flyers, postcards, one pagers, news/research article, etc.) Have your received prior exhibitor or marketing approval from the OMA in the past? (Choices include Yes or No) By submitting this form, you acknowledge reading and agreeing to the OMA’s Exhibitor Rules and Regulations and Antitrust Guidelines. Additional information will be required to exhibit, sponsor, or advertise and approval is not guaranteed.

Commented [TF1]: Suggest eliminating this question & substituting with the question immediately below. Commented [EL2]: I would combine these as follows: “Does your company sell HCG, compounded semaglutide, compounded tirzepatide, compounded retatrutide, or other peptides for weight loss?