Symposium Sponsor Registration Symposium Sponsorship Registration Company Name * Contact Person First Name * Contact Person Last Name * Email Address * Company Phone Number Company Mailing Address Company Mailing Address Company Mailing Address Company Mailing Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Company Website * Be sure to include http://www. with your web address Logo Upload * Drop a file here or click to upload Choose File Required upload size: 15MB Recommend a high quality PNG image with a transparent background Sponsorship Package * Presenting Sponsor - $6,500 (NE Spine and Pain)Supporting Sponsor - $3,000 (Three Available)Bottled Water & Soft Drinks Sponsor - $2,500 (One Available)WIFI/Power Package - $2500 – (OrthoNebraska/Makovicka Physical Therapy)Pastries/Snacks/Coffee Sponsor-$2,500-One AvailableVendor Option 1 - $800Vendor Option 2 - $500 Presenting Sponsor Header Logo UploadMust be a PNG ImageMust have transparent backgroundHighly suggest a white logo as it will be placed on dark background * Drop a file here or click to upload Choose File Required upload size: 15MB MUST BE A PNG IMAGE WITH TRANSPARENT BACKGROUND IN A LIGHT COLOR (will be placed on dark background) Prominent logo on sponsor page of website Logo on homepage of conference website Premium booth placement (10’ x 20’) Four (4) free conference registrations Prominent logo on promotional emails Prominent logo on screen between sessions One (1) allotted timeslot for presenter Exclusive cocktail reception sponsor Includes signage & koozies Exclusive lunch sponsor Includes signage & 5-minute presentation Logo on all printed materials Option to provide printed ad, lanyards, notepads & pens Option for added raffle prize Prominent logo on sponsor page of website Premium booth placement (10’ x 10’) Three (3) free conference registrations Logo on promotional emails Logo on screen between sessions Sponsor of power/charging stations at each table Sponsor of Wi-Fi for entire event Prominent logo on sponsor page of website Premium booth placement (10’ x 10’) Table tents with “Power and Wi-Fi provided by (company logo)” Two (2) free conference registrations Logo on promotional emails Logo on screen between sessions Booth Space (10’ x 10’) Logo on sponsor page of website Two (2) free conference registrations Logo on screen between sessions Logo on Printed Materials Option for added raffle prize Booth Space (10’ x 10’) One (1) free conference registration Option for added raffle prize Total Payment Type * Credit CardInvoice/Check Please mail checks to: PO Box 24054 Omaha, NE 68124 Make checks payable to “Workers Compensation Association of Nebraska” Cardholder First Name * Cardholder Last Name * Credit Card * Billing Address/Credit Card Address * Billing Address/Credit Card Address Billing Address/Credit Card Address Billing Address/Credit Card Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal If you are human, leave this field blank.
