Consistent Life 25th Anniversary Organization Participation Form

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Organization Participation Form
Consistent Life 25th Anniversary Conference
March 9-11, 2012
National 4-H Youth Conference Center
Chevy Chase, Maryland, USA

For full information on the Consistent Life 25th Anniversary Conference and details on the ways organizations can participate, see the Conference Web site.

Name of Organization *

Name of Contact Person *

Contact E-mail Address: *

Contact phone number *

Street address/PO Box *

City *

State/Province *

Postal Code *

Country *

Type of Co-sponsorship

Platimum $750
Gold $350
Silver $200

Web address to use as link in co-sponsor list

Options instead of or in addition to co-sponsorship

Full page ad in Conference program $150

Half page ad in Conference program $85

Quarter page ad in Conference program $50

Full page insert in Conference packet $50

Six-foot display table, with 2 chairs $100

Need electricity for table (no extra charge)

Yes
No

We will publicize the Conference in (check all that apply)

Web site
Print publication or mailing
Email to our list

Donation (show amount)

We want to be a part, but are struggling with funding

TOTAL AMOUNT *

Payment option *

Check to Consistent Life, PO Box 9295, Silver Spring, MD 20916-9295
Online payment option at http://www.consistent-life.org/join.html

Name of person attending conference as part of Co-Sponsor package

Name of 2nd person attending conference as part of Platinum package

Comments

Verification Code: Visual Verification Image

Enter Verification Code: *

* Required