Form Submit Date

Organization

Contact Name

Address City State Zip

Phone Email

SPONSORSHIP CATEGORY

Platinum Sponsor

Gold Sponsor

Silver Sponsor

Bronze Sponsor

Corporate Sponsor

In-Kind Sponsor

OTHER:

Sponsorship Item

Contribution

The convention committee reserves the right to reject or modify naming rights for any reason, including appropriateness.  Certain items are time sensitive.  Sponsorship will be included on promotional items printed after receipt of this application only if received by the April 1st conference publication cut off date.