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Name of Company (as the company wishes to be acknowledged): *

Primary Contact Info

Name:

Title:

Email:

Business Phone:

Cell Phone:

Fax Number:

Mailing Address

Street:

Suite:

City:

State:

Zip:

Are there additional contact persons for specific follow up tasks, such as:

Secondary general contact
Assistant to primary contact
Logo
Ad for program book
Registration of company attendees
Exhibition Hall booth
Shipping

Alternative Contact #1

Contact Responsibility
Please indicate area(s) of responsibility for this additional contact person:

Name:

Title:

Email:

Business Phone:

Cell Phone:

Fax Number:

Mailing Address

Street:

Suite:

City:

State:

Zip:

Alternative Contact #2

Contact Responsibility
Please indicate area(s) of responsibility for this additional contact person:

Name:

Title:

Email:

Business Phone:

Fax Number:

Cell Phone:

Mailing Address

Street:

Suite:

City:

State:

Zip:

Alternative Contact #3

Contact Responsibility
Please indicate area(s) of responsibility for this additional contact person:

Name:

Title:

Email:

Business Phone:

Cell Phone:

Fax Number:

Mailing Address

Street:

Suite:

City:

State:

Zip:

Does your company or organization have a required proposal or application process for sponsorship?

If yes, please provide the URL for the guidelines or forms needed:

Contact person’s information for questions related to the proposal/application process

Name:

Title:

Email:

Business Phone:

Cell Phone:

Fax Number:

Mailing Address

Street:

Suite:

City:

State:

Zip:

Additional comments about the proposal/application process:

Invoice Contact Information

Payment for sponsorship is net 30 of receipt of invoice, unless other arrangements are made. Also please note that Sponsors whose payment is received by March 31, 2012, receive 1 extra complimentary three-day Summit registration and listing in the official 2012 Workplace Summit invitations.

Is your invoice contact someone other than your primary contact?

Name:

Title:

Email:

Business Phone:

Cell Phone:

Fax Number:

Mailing Address

Street:

Suite:

City:

State:

Zip:

Sponsorship Level

Four positions available – choose one:

Eight positions available – (choose one):

[One hundred positions available]:

[Unlimited positions]:

Other Custom Level Package

Custom Sponsorship Amount: $

Sponsor Upgrades

Note: A copy of this form will be e-mailed to you. Thank you for your sponsorship commitment.

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2012 Out & Equal Workplace Summit Sponsor and Partner Opportunities

Sponsorship Level

Sponsor Upgrades