Vendor Registration

Vendor Registration
Name

First NameLast Name
Company
Will you be paying by check or online?

Sending CheckPay Online
IF PAYING BY CHECK:
Please select which option you are paying for:

Bronze - $500 - (does not include any guest passes.)Silver - $1,500 - (comes with two (2) guest passes.)Gold – $2,000 - (comes with one (1) guest pass.)Platinum - $3,000 - (comes with three (3) guest passes.)
I am purchasing this many guest passes: ($200/ea)
Checks can be made to:

Illinois Hearing Society
1 N Old State Capitol Plaza
#410
Springfield, IL 62701
IF PAYING ONLINE:

Please select your sponsorship level and proceed to "submit" to complete payment. *PLEASE NOTE: a 3% processing fee is reflected in all prices for online payment. To avoid this fee, please apply/pay by check
Please select your sponsorship level:

Bronze - $515 - (does not include any guest passes.)Silver - $1,545 - (comes with two (2) guest passes.)Gold – $2,060 - (comes with one (1) guest pass.)Platinum - $3,090 - (comes with three (3) guest passes.)
I am purchasing this many guest passes: ($206/ea)
Please enter the amount selected above (total):

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USDPayment Amount
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IF PAYING BY CHECK: