Non-Sponsor Purchase Agreement Form

2010 Out & Equal Workplace Summit Non-Sponsor Purchase Agreement

Thank you for your participation in the 2010 Out & Equal Workplace Summit to be held October 5-8 in Los Angeles, California.

Please complete this entire enrollment form, inserting N/A if a line does not apply to your company’s Summit purchase. If you have questions, please contact Sherrie Holmes at 415-694-6508 or sholmes@OutandEqual.org.

This form must be filled out online, all at one time. Once you press the button to “submit” the form to Out & Equal, a copy will be sent automatically to your email address.

Name of Company (as you want 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:

Cell Phone:

Fax Number:

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:

Invoice Contact Information

Payment for Non-Sponsor Summit Purchase(s) is net 30 days from receipt of invoice, unless other arrangements are made.

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:

Non-Sponsor Purchase Options

[Non-Sponsor options]:

Non-Profit Purchase Options

[Available only to 501(c)3 organizations]:

Booth ($1,500)

Half-Page Program Book Ad ($1,500)

Sponsor Upgrade Purchases

[Available only to committed sponsors]:

Additional Exhibit Hall Booth ($2,500)

Additional Full-Page Ad in Program Book ($2,500)

Upgrade from Half-Page Ad to Full-page Ad in Program Book ($1,500)

Comments about purchased items:

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2010 Out & Equal Workplace Summit Non-Sponsor Purchase Agreement

Non-Sponsor Purchase Options

Non-Profit Purchase Options

Sponsor Upgrade Purchases