APTA On-Line Sponsorship Agreement

	APTA / Colorado Chapter Secure On-Line Sponsorship Agreement
	Please review the APTA Sponsor Guidelines, then complete all information below. Click SEND to submit your Sponsorship Agreement to the APTA / Colorado Chapter office electronically. Please note: A confirmation page will appear if your registration was transmitted successfully. If you do not see a confirmation page, it may be necessary to resubmit your registration or send via fax to the APTA / Colorado Chapter office at (303) 694-4869.
	*Company Information (this information will appear in publications)* Company Mail address City, State/Province Postal code Country Phone Fax E-mail Web *Primary Contact Person* to receive confirmation details Contact person Title Mail address City, State/Province Postal Code Contact Direct e-mail Contact Direct phone Contact Direct fax *Sponsorship* Please review the APTA Sponsor Guidelines for a complete description of various sponsorship levels. Platinum Sponsor $1,200 or More Type of sponsorship (ie: meal, reception, speaker) Gold Sponsor Plus $900 Gold Sponsor $550 Silver Sponsor $400 Bronze Sponsor $250 *Table Top Display Request* Spring Convention 2010 Fall Symposium 2010 Other Event: Electrical access requested *Product & Services Description* This information will be included in our Exhibitor Directory provided to Convention registrants *Exhibit Personnel Registration* Please list names of your exhibit personnel who will attend the show. 1. 2. TOTAL AMOUNT DUE *Total Amount Due* in U.S. dollars A minimum 50% deposit is required with initial agreement; balance is due no later than 30 days prior to the event.. Amount to be charged now $ *Payment* VISA MasterCard American Express A company check will be issued within 10 business days. Display space cannot be held until your deposit is received. Cardholder name Card number please include dashes Expiration date *Comments?*
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	APTA / Colorado Chapter 7400 East Arapahoe Road, #211, Centennial, CO 80112 U.S.A. Phone (303) 694-4728 Fax (303) 694-4869 apta@assnoffice.com © 2010 APTA / Colorado Chapter. All rights reserved.