2021 Professional Seminar
Sponsorship Form
Title
*
Please Select
Mr.
Mrs.
Ms.
Miss
Dr.
Hon.
Rev.
Full Name
*
First Name
Last Name
Organization Name
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate if the address above is your business or home address
*
Please Select
Business
Home
Please fill out your credit card information below to complete your sponsorship:
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Supporting Sponsor
Includes 4 complimentary registrations
$
2,500.00
Engagement Sponsor
Includes 8 complimentary registrations
$
3,500.00
Partner Sponsor
Includes 12 complimentary registrations
$
5,000.00
Major Sponsor
Includes 16 complimentary registrations
$
10,000.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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