Sponsor Registration Online

B2B Sponsor Registration 2012

	* - Indicates a required field
*	Company:
*	Company Description:	25 words or less
*	Contact Name:
	Title:
	Address:
	City:
	State:
	Zip:
*	Phone:
	Fax:
*	E-mail address:
*	Sponsorship Level:	Platinum Sponsor ($ 10,000)Gold Sponsor ($ 5,000)Gold Sponsor w/Goodie Bag ($ 6,000)Prime Sponsor ($ 2,500)Major Sponsor ($ 850)Media Sponsor ( Call For Details)
*	Sponsor Status:	Member 1-3 employeesMember 4 or more employeesNon-Member 1-3 employeesNon-Member 4 or more employees
*	Number of Booths:
	Optional Items:	Carpeting for Booth (4x7) $ 20 Waste Basket $ 5 Electronic Attendee List $ 25 Electricity (1-120/5amp) N/C Electricity (2-120/5amp) N/C Electricity Other Enter details in comments Offering Food Samples N/C Offering Door Prize(s) N/C Need Sign N/C Have Previous Years Sign N/C No Sign Needed N/C
	Bag Lunches:	Ham @ $ 12 each Turkey @ $ 12 each Veggie @ $ 12 each
	Representative Nametags:	$2 charge $2 charge $2 charge $2 charge Enter additional names in comments and add $2 per nametag to the total
	Comments:
	Booth Choices:	1st Choice: 2nd Choice: 3rd Choice: 4th Choice: 5th Choice: Enter any conditionals in comments for additional choices if none of these are available
	reCaptcha: