Application for Sponsorship
Sponsoring Company Information
Organization Name
*
Primary/Planning Contact Name
*
First Name
Last Name
Primary/Planning Contact Email
*
example@example.com
Primary/Planning Contact Phone
*
Please enter a valid phone number.
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website
*
Description of Company and Services
*
Is your company a 501(c)(3) Non-Profit?
Please Select
Yes
No
Not-for-profit organizations receive a 10% discount. Proof of tax exemption is required.
Exhibitor Information
Does your exhibit require power?
Please Select
Yes
No
Unknown
Request to not place booth next to specific competitors or other exhibitors:
Booth Representative Name #1 (if known)
First Name
Last Name
Booth Representative #1 Title
Booth Representative #1 Email
example@example.com
Booth Representative #2 Name (if known)
First Name
Last Name
Booth Representative #2 Title
Booth Representative #2 Email
example@example.com
Deliverables
Upload 1-2 High-Resolution Versions of your Logo
Browse Files
Drag and drop files here
Choose a file
png preferred
Cancel
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Sponsorship Levels and Payment Information
Select your sponsorship level. Within 30 days of application submittal, payment is due. Please note, CREDIT CARD PAYMENTS SUBJECT TO 3% PROCESSING FEE. To proceed to pay with a card, call Maryellen Sims, Controller at Colorado Retina Associates directly at 720-420-3274. If you prefer to pay by check, you can send an invoice request to Kendall Turner at kturner@retinacolorado.com. Checks to be mailed to Colorado Retina Associates C/O MaryEllen Sims- 255 S. Routt St. Suite 200, Lakewood, CO 80228.
Sponsorship Levels
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( X )
Diamond
$
5,000.00
Quantity
1
Platinum
$
3,500.00
Quantity
1
Gold
$
2,500.00
Quantity
1
ADD ON: Badge Sponsor
Attendees name badge will be branded with your logo. Only one available- first some, first serve.
$
500.00
Quantity
1
ADD ON: Breakfast Sponsor
Your logo on itemized food tags and (1) 24"x36" poster advertising your products and services near the food station. Only one available- first some, first serve.
$
500.00
Quantity
1
ADD ON: Lunch Sponsor
Your logo on itemized food tags and (1) 24"x36" poster advertising your products and services near the food station. Only one available- first some, first serve.
$
500.00
Quantity
1
ADD ON: Snack Sponsor
Your logo on itemized food tags and (1) 24"x36" poster advertising your products and services near the food station. Only one available- first some, first serve.
$
500.00
Quantity
1
ADD ON: Beverage Station Sponsor
Your logo on itemized beverage tags and (1) 24"x36" poster advertising your products and services near the beverage station. Two available- first some, first serve.
$
500.00
Quantity
1
2
ADD ON: Lanyard Sponsor
Attendees lanyard attached to their name badge will be branded with your logo. Only one available- first some, first serve.
$
500.00
Quantity
1
Billing Email
example@example.com
Declaration
By submitting this application, I confirm that the information provided is accurate, I have read and agree to the Exhibitor Rules and Regulations, and I agree to either use the credit card processing feature provided within this form or submit payment by check or phone within 30 days of application submittal.
Name
*
First Name
Last Name
Signature
*
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