CityMatCH Conference Exhibitor/Co-Sponsor Application - CityMatCH: Improving the Health of Urban Women, Children and Families

EXHIBITOR/CO-SPONSOR APPLICATION

* indicates required fields

Exhibitor/Co-Sponsor Information
(as it will be listed in the conference program)

*Organization:

*Address Line 1:

Address Line 2:

Address Line 3:

*City:

*State: *ZIP code: -

Website:

Contact Information
(of person responsible for the exhibit/co-sponsorship)

*First Name:

*Last Name:

MI:

*Title:

*Phone: ( ) - Extension:

Fax: ( ) -
*Email:

*Organizational Type

Non-Profit/Government

For-Profit/Corporate

*Exhibitor/Co-Sponsorship Levels

Choose your exhibitor/co-sponsorship option(s):

Pearl Level
Promotional Materials
$200

$300

Sapphire Level
Exhibitor
$250

$375

Ruby Level
Exhibitor and Conference Attendee
$625

$775

Emerald Level
Exhibitor, Conference Attendee,
Session and Speaker Sponsor
$1100

$1250

Diamond Level
Special Event and Emerging MCH Leader Scholarship Sponsor
Prices Available upon Request

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Exhibitor/Co-Sponsor Information (as it will be listed in the conference program)
*Organization:
*Address Line 1:
Address Line 2:
Address Line 3:
*City:
*State:	*ZIP code: -
Website:

Contact Information (of person responsible for the exhibit/co-sponsorship)
*First Name:
*Last Name:
MI:
*Title:
*Phone:	( ) - Extension:
Fax:	( ) -
*Email:

*Organizational Type
	Non-Profit/Government
	For-Profit/Corporate

*Exhibitor/Co-Sponsorship Levels
Choose your exhibitor/co-sponsorship option(s):
	Pearl Level Promotional Materials	$200 $300
	Sapphire Level Exhibitor	$250 $375
	Ruby Level Exhibitor and Conference Attendee	$625 $775
	Emerald Level Exhibitor, Conference Attendee, Session and Speaker Sponsor	$1100 $1250
	Diamond Level Special Event and Emerging MCH Leader Scholarship Sponsor	Prices Available upon Request