Gold, Silver, or Bronze Sponsor - Organization for Human Brain ...

Exhibitor/Sponsorship
Application Form
Please note: All acknowledgements of your company and listing of company name and address will be generated from the following information.
Company Name
Company Phone
Contact Name
Direct Phone
Address
Fax
City
Website
State/Province
Company Email
Postal/Zip Code
Direct Email
Country
Exhibiting
Total number of booths requested
Amount to be charged on card
Deposit for each booth ($2,000) Full amount for each booth ($3,100) Nonprofit ($1,000)
50 word company description to be included in the onsite program
Sponsorship Opportunities
Club Night Party ($50,000)
Welcome Reception ($50,000)
Mobile App ($50,000)
Leadership Dinner ($25,000)
Coffee Break ($25,000)
Internet Cafe ($25,000)
Poster Social ($25,000)
Online Library ($10,000)
Meeting Lanyards ($10,000)
Meeting Pads and Pens ($10,000)
E-Posters ($10,000)
Gold Sponsorship = $50,000
Silver Sponsorship = $25,000
Bronze Sponsorship = $10,000
Total Exhibit Booth Amount
Total Sponsorship Amount
Payment Information
Sponsorship Payment: A 50% non-refundable deposit must be received before this application will be processed. Balance to be paid by May 14, 2012.
Exhibit Payment: Exhibit Booth deposit is due by April 16, 2012. Balance to be paid by May 14, 2012.
Total Amount Due
We would like to use the following credit card for payment: Mastercard Visa AMEX
Credit Card No. Exp. Date Name on Card
Enclosed is our check made payable to OHBM Check #
Signature
Date
Please return the completed form by faxing to 952-545-6073, scanning to info@humanbrainmapping.org, or mailing to the address below.
Organization for Human Brain Mapping
5841 Cedar Lake Road, Suite 204 | Minneapolis, MN 55416 | Phone: 952-646-2029 | Fax: 952-545-6073 | Email: info@humanbrainmapping.org
June 10-14, 2012
China National Convention Center (CNCC)