2019 Annual West Coast District Sponsorship Application

2019 Annual West Coast District Sponsorship Application

To register as a sponsor and make a payment, please complete all of the fields below:
Name *

First Name Last Name
Company Name *
E-mail *
Work Number

Area Code Phone Number
Mobile Number

Area Code Phone Number
Sponsorships
- Diamond
- Platinum
- Gold
- Networking/Social
- Educational Event Lunch
Select your Sponsorship level and enter your credit card information below.

If paying by check, please contact west@flccim.com

Payment: *

Diamond Sponsor $ 5,000.00

Platinum Sponsor $ 2,500.00

Gold Sponsor $ 1,500.00

Networking/Social Sponsor $ 950.00

Educational Event Lunch Sponsor $ 500.00

Billing Address *