Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Person *

First Name

Last Name

Contact Telephone Number

(###)

###

####

Sponsorship Packages *

$10,000.00 - Premier (One Sponsor Only)

$8,000.00 - Diamond

$5,000.00 - Platinum

$3,000.00 - Gold

$1,000.00 - Silver

$500.00 - Bronze

$2,000.00 Seminar Happy Hour (One Sponsor Only)

$300.00 - One Monthly CLE Luncheon

Alternative Sponsorship

Date

MM

DD

YYYY

Method of Payment

Pay By Check

Pay By Credit Card (additional processing fees will apply)