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Adolescent Symposium 2023 Sponsorship
Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Phone
*
Invoice Contact
*
If invoice needs to go to someone other than the main contact, please provide:
Verify Email
*
Organization/Employer
*
Company Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Sponsorship Levels
*
Quantity
$10,000
-
Premier
0
1
1
$7,500
-
Diamond
0
1
1
$4,000
-
Platinum
0
1
1
$2,500
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Gold
0
1
1
$750
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Table Top Exhibitor * Does not include a registration to the conference*
0
1
1
$50
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Table Sitter * Does not include a registration to the conference*
0
1
2
2
$30
-
110V Electric Outlet for your Exhibit Table – if you require electricity
0
1
1
Comments or Questions
Agreement
*
I agree that I am an approved representative of my organization to accept sponsorship information and processing.
I agree
IMPORTANT NOTICE
*
All sales are final, No Refunds. Payment Terms are credit card or Net 30 from the date of this form. Late Payments may incur a fee. Photography, audio, or video recording is strictly prohibited without written permission from MHA of Greater Dallas. No outside Food or Beverages are allowed, except candy at your table to give away. CDC Guidelines will be in place as needed.
I have read and accept the above notice.
Add 3% to my total amount to help cover the payment processing fees
