Sponsor Agreement Step 1 of 333%Which Event are you sponsoring?*Select event --->Agriculture Safety DayConstruction Safety DayGovernor's ConferenceGovernor's Conference Poletop RescueMaritime Safety DayWhat type of sponsorship are you providing?CashIn-Kind Donation or ServiceBoth Cash + In-KindCash Sponsor Amount$1000$500$250OtherNoneCash Sponsor Amount$5000$2500$1000$300OtherNoneOther AmountCash Total for Billing Price: $0.00 Cash Total for Payment OptionsIn-kind donationEstimated value of in-kind donationTotal estimated value of SponsorshipExhibitor Package Requested?YesNoPlatinum sponsors receive a complimentary exhibit booth. Check No to opt out of receiving this benefit.Choose Exhibitor Benefits PackageBooth and AdvertisementDecline Exhibitor Benefits PackagePlatinum and Gold sponsors receive a complimentary exhibit booth and program advertisement.Company*Website Company Description*Company LogoAccepted file types: jpg, gif, png.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 $0.00 Select Payment OptionCheckCredit CardCredit CardAmerican ExpressMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 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.CAPTCHAΔ
