Sponsor Agreement "*" indicates required fields Step 1 of 3 33% Which Event are you sponsoring?*Select -->Agriculture Safety DayConstruction Safety DayGovernor's ConferenceGovernor's Conference Pole Top RescueMaritime Safety DayWhat type of sponsorship are you providing?* Cash In-Kind Donation or Service Both Cash + In-Kind Cash Sponsor Amount $1000 $500 $250 Other None Cash Sponsor Amount $5000 $2500 $1000 $300 Other None Other AmountCash Total for Billing Price: $0.00 HiddenCash Total for Payment OptionsIn-kind donation Estimated value of in-kind donationHiddenTotal estimated value of SponsorshipExhibitor Package Requested? Yes No Platinum sponsors receive a complimentary exhibit booth. Check No to opt out of receiving this benefit.Choose Exhibitor Benefits Package Booth and Advertisement Decline Exhibitor Benefits Package Platinum and Gold sponsors receive a complimentary exhibit booth and program advertisement. Company* Website Company Description*Company LogoAccepted file types: jpg, gif, png, Max. file size: 4 MB.Upload a high quality company logo for use in promotional materials according to your sponsorship level. Accepted file formats are jpg | gif | png. Name* First Last Billing Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Enter Email Confirm Email Phone*Total Due Select Payment Option Check Credit Card Credit Card American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name Terms & Conditions* 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.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
