Benton Institute for Broadband and Society · Chicago and DC Event- Credit Card

I would like to make this purchase on behalf of:

*

Myself

An Organization

Organization/Employer

*

Sponsorship

$25,000 - Diamond Sponsor- includes up to 10 tickets

$10,000 - Platinum Sponsor- includes up to 8 tickets

$7,500 - Gold Sponsor- includes up to 6 tickets

$5,000 - Silver Sponsor- includes up to 4 tickets

$2,500 - Bronze Sponsor- Includes up to 3 tickets

$1,000 - Copper Sponsor- includes up to 2 tickets

$0 - I would like to make a donation or buy tickets below

Please reserve the following sponsorship tickets for DC

*

Please upload a PNG logo File

Please upload a High Res Jpg Logo

DC Event Tickets- April 6, 2022	Quantity
$400 - Anniversary Ticket- DC Event
$250 - Friend Ticket- DC Event
$150 - Supporter Ticket- DC Event
$75 - Non Profit and Government Staff Advocate Ticket - DC Event

I am unable to join the DC celebration, but would like to make a donation to support the mission of the Benton Institute

$5,000

$2,500

$1,000

$500

$250

$100

$

Contact Information

Name

*

First Name

Last Name

Name of Non Profit Organization or Government Agency/Office

*

Email

*

Verify Email

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

My 1st DC Guest

First Name

Last Name

My 2nd DC Guest

First Name

Last Name

My 3rd DC Guest

First Name

Last Name

My 4th DC Guest

First Name

Last Name

My 5th DC Guest

First Name

Last Name

My 6th DC Guest

First Name

Last Name

My 7th DC Guest

First Name

Last Name

My 8th DC Guest

First Name

Last Name

My 9th DC Guest

First Name

Last Name

My 10th DC Guest

First Name

Last Name

My 11th DC Guest

First Name

Last Name