Step 1 of 2 50% NameThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formSponsor IDWhich Event are you sponsoring?(Required)Select –>Agriculture Safety DayConstruction Safety Day / Maritime Safety DayGovernor's Industrial Safety and Health ConferenceGovernor's Industrial Safety and Health Conference Pole Top RescueWhat type of sponsorship are you providing?(Required) Cash In-Kind Donation or Service Both Cash + In-Kind Cash Sponsor LevelPlease fill out other fields.Other Cash AmountTotal Cash Amount Price: $0.00 In-kind donation(Required)Fully describe your donation. Specify items and quantities.Estimated value of in-kind donation(Required)Board Contact NameEnter the name of the Board Director or person you are working with to receive the donation, if any.Board Contact InfoEnter the email or phone number of your Board contact.This field is hidden when viewing the formTotal Value of SponsorshipThis field is hidden when viewing the formInitial BenefitsAvailable Benefits – Fill Out Other Fields – The above benefits are provided for Sponsors. Uncheck any benefits you wish to decline.You will be listed on the website and at the event. Company InformationCompany Name(Required)Conpany Logo Image(Required) Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 8 MB, Max. files: 1. Upload an image that has a 1:1 ratio, minimum of 300x300px. You will be able to crop the image when uploading to fit these requirements.Your Name(Required) First Last Your Email(Required) Enter Email Confirm Email Your Contact Phone(Required)Billing Address(Required) Street Address Address Line 2 City State 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 ZIP Code Terms & Conditions(Required) I agree to the terms & conditions.Donations designated for specific activities and events which remain after such activities or events are concluded will be allocated at the discretion of the Governor’s Industrial Safety and Health Advisory Board.Payment InformationTotal Amount Due Select Payment Option(Required) Check Credit Card Credit Card(Required)Card Details Cardholder Name This field is hidden when viewing the formEvent YearThis field is hidden when viewing the formBooth TypeThis field is hidden when viewing the formValue of exhibit boothThis field is hidden when viewing the formValue of Passport to SafetyThis field is hidden when viewing the formNumber of attendee registrationsThis field is hidden when viewing the formValue of single attendee registrationThis field is hidden when viewing the formValue of attendee registrationsThis field is hidden when viewing the formAd SizeThis field is hidden when viewing the formValue of program adThis field is hidden when viewing the formTotal value of sponsor benefitThis field is hidden when viewing the formBooth Discount CodeThis field is hidden when viewing the formAttendee Discount Code
