Participant Name / Company
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First Name
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Last Name
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Email
*
Phone
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Address
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City
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State
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Postal code
*
I have read the benefits of sponsorship and have chosen to participate in the following level:
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Platinum Sponsor - $50,000
Gold Sponsor - $25,000
Silver Sponsor - $12,500
Bronze - $7,500
Burgundy - $3,125
Custom - please contact me!
I agree that you may use my name in the pre- and post- event publicity as well as the Auction Program book
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Yes
No, I Prefer to Remain Anonymous
Submit