Exhibitor and Sponsor Prospectus - Organization for Human Brain ...

Exhibitor/Sponsorship ApplicATION Form
Company Information
Please note: All acknowledgements of your company and listing of company name and address will be generated from the following information.
Sponsorship Opportunities
Club Night Party ($35,000)
Company Name
Address 1
Address 2
City
Postal/Zip Code
Country
Company Phone
Company Email
Website
Welcome Reception ($35,000)
Leadership Dinner ($25,000)
Coffee Break ($25,000)
Internet Cafe ($25,000)
Poster Social ($25,000)
Online Library ($15,000)
Company Representative Information
Contact Name
Phone
Email
Exhibiting
Total number of booths requested
Amount to be charged on card
Deposit for each booth ($2,000) Full amount for each booth ($4,000) Nonprofit Booth ($2,000) Nonprofit Table Top (Gratis)
Meeting Lanyards ($15,000)
Meeting Pads and Pens ($15,000)
E-Posters ($15,000)
Mobile App: Overall App Sponsorship
($5,000 USD)
Mobile App: Multimedia Ad Package
($2,000 USD each)
Mobile App: Banner Ad/Landing Page
Ad Package ($1,000 USD each)
Total Exhibit Booth 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 20, 2013.
Exhibit Payment: Exhibit Booth deposit is due by April 22, 2013. Balance to be paid by May 20, 2013.
Total Amount Due
Gold Sponsorship = $35,000
Silver Sponsorship = $25,000
Bronze Sponsorship = $15,000
Total Sponsorship Amount
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
Apply online at www.humanbrainmapping.org/Exhibit2013