Sponsorship Completion Select a Corporate Sponsorship level below!Sponsorships (in USD) Bronze Corporate ($1,000.00) Silver Corporate ($2,000.00) Gold Corporate ($3,000.00) Platinum Corporate ($6,000.00) Diamond Corporate ($12,000.00) Diamond Elite Corporate ($15,000.00) In-Kind Service/Product Donation Invoice Number(Required)Please provide the invoice number associated with this sponsorshipCustom Amount (If sponsoring at an established level, leave this blank): This cell is available for sponsors to provide support at a level they are comfortable with. If this option is selected, our corporate relations will be in touch to discuss any associated benefits for this sponsorship level.Notes/Comments regarding your Custom Amount (If sponsoring at an established level, leave this blank):Notes/Comments regarding your In-Kind Service/Product Donation:e.g., What is the item, how many items, value of each item, etc.Total Amount of Sponsorship Orginization/Company InformationOrganization/Company Name(Required)Contact Person(Required)Title(Required)Phone(Required)Email(Required) Enter Email Confirm Email Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please indicate how many years your Company has been a sponsor of NGALA.(Required)Please enter a number greater than or equal to 0.Company Booth InformationWill you setup a booth?(Required) Yes No If setting up a booth, please indicate how many tables you will require.(Required)Please enter a number greater than or equal to 0.For planning purposes, 2 chairs per table. If setting up a booth, do you need power?(Required) Yes No Saturday Morning Business Session (0830-1400)Will someone be available to attend the Business Session when we recognize the sponsors?(Required) Yes No Full agenda on the State Conference page.Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Total Following your submittal, don’t forget to return to the Corporate Sponsorship page to register your attendees
