REGISTRATION FORM
WESTMARC’s
Economic Development Summit, 2015
Please reserve: ______ Gold/Silver/Bronze Sponsorship Level at $______________________ ______ Table Sponsor $600 each for Members
Thursday, April 16, 2015
Registration 9:00 a.m. - Program Begins 10:00 a.m. The Wigwam Resort | 300 East Wigwam Blvd | Litchfield Park
______ Table Sponsor $750 each for Non-Members ______ Seat(s) at $60 each for Members ______ Seat(s) at $75 each for Non-Members
SPONSORSHIP LEVELS
Please provide Company information (please type):
__________________________________________________________________ Company Name
___________________________________________________________________ Address
___________________________________________________________________
City/Zip
___________________________________________________________________
Contact Name
___________________________________________________________________ Phone Email
Please list attendees below (please type):
Gold Table for 10 - Gold Preferred Seating $2,500 Additional Seat at Head Table Logo Recognition on All Event Materials Corporate Logo Scrolled During Event Podium Acknowledgement at the Event Silver Table for 10 - Silver Preferred Seating $1,500 Logo Recognition on All Event Materials Corporate Logo Scrolled During Event Podium Acknowledgement at the Event Bronze Table for 10 - Bronze Preferred Seating $1,000 Corporate Logo on All Event Materials Corporate Logo Scrolled During Event Table Table for 10 - Reserved Seating Members $600 Sponsor Corporate Name on Table Sign Non-Members $750 Individual Members $60 Seat Non-Members $75
Payment Information:
1. _________________________________________________________________ ____ I prefer to have WESTMARC contact me for my Name credit card information: (_______)___________________ _________________________________________________________________ (Area Code) / Phone Number Company 2. _________________________________________________________________ Or, please complete the credit card information below: Name ________________________________________________ _________________________________________________________________ Company Name Company 3. _________________________________________________________________ ________________________________________________ Name Name on Card _________________________________________________________________ ________________________________________________ Company 4. _________________________________________________________________ Name _________________________________________________________________ Company 5. _________________________________________________________________ Name _________________________________________________________________ Company 6. _________________________________________________________________ Name _________________________________________________________________ Company 7. _________________________________________________________________ Name _________________________________________________________________ Company 8. _________________________________________________________________ Name _________________________________________________________________ Company 9. _________________________________________________________________ Name _________________________________________________________________ Company 10. _________________________________________________________________ Name _________________________________________________________________ Company
WESTMARC | 14100 N. 83rd Ave, Suite 150 |
Billing Address
________________________________________________ City Zip ________________________________________________ Type of Credit Card ________________________________________________
Credit Card #
________________________________________________ Exp Date CID
________________________________________________ Total Amount $
________________________________________________
Please Provide E-Mail Address for Credit Card Receipt
Make checks payble to WESTMARC Or complete credit card information above. Deadline to register: April 10, 2015 Please deliver completed form via mail, e-mail or fax to:
WESTMARC
Attn: Economic Development Summit 2015 14100 N. 83rd Ave, Suite 150, Peoria, AZ 85381 E-mail:
[email protected] | Fax: 623-435-0485
Peoria, AZ 85381 | 623-435-0431 x203 | Fax 623-435-0485
