2027 sponsor registration TOTL

company information

Company Name

Contact Person

PrefixFirst NameLast Name

Title

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone

Format: (000) 000-0000.

Fax

Format: (000) 000-0000.

E-mail

Confirmation Email

payment options

Method of Payment

Sponsor Levels & Add-ons

Presenting Sponsor$8,192.00

$8,000 + 2.4% processing fee

Keynote Sponsor$4,096.00

$4,000 + 2.4% processing fee

Platinum Sponsor$2,560.00

$2,500 + 2.4% processing fee

Exclusive Tote Bag Sponsor$2,560.00

$2,500 + 2.4% processing fee

Tote Bag Sponsor$1,024.00

$1,000 + 2.4% processing fee

Gold Sponsor$1,024.00

$1,000 + 2.4% processing fee

Silver Sponsor$512.00

$500 + 2.4% processing fee

Table w/Representative (if not included in sponsorship level)$333.00

$325 + 2.4% processing fee. Exhibitor table with one representative

Additional Representative at Exhibitor table$179.00

$175 + 2.4% processing fee. Second representative at Exhibitor table

Total $0.00

Sponsorship Level (choose one)

Exhibitor table w/ one representative requested (included in your sponsorship level)

Exhibitor table requested ($325) - includes one representative

Would you like a second representative at your exhibitor table ($175)?

1. Name of representative at the Exhibitor table

1. E-mail of Exhibitor table representative

Confirmation Email

1. Vegetarian meal?

2. Name of representative at the Exhibitor table

2. E-mail of Exhibitor table representative

Confirmation Email

2. Vegetarian meal?

Representatives (included in your sponsorship levels)

Presenting Sponsor- 8
Keynote Sponsor - 6
Platinum or Exclusive Tote Sponsor - 3
Tote Bag Sponsor, Gold Sponsor, Silver Sponsor- 1

Will you have representatives (excluding Exhibitor Table representatives) attending conference?

Will above contact person be attending?

Please list the name and email address for each attendee:

(do not include Exhibitor Table representatives)

1. Full Name

PrefixFirst NameLast Name

1. E-mail

Confirmation Email

2. Full Name

PrefixFirst NameLast Name

2. E-mail

Confirmation Email

3. Full Name

PrefixFirst NameLast Name

3. E-mail

Confirmation Email

4. Full Name

PrefixFirst NameLast Name

4. E-mail

Confirmation Email

5. Full Name

PrefixFirst NameLast Name

5. E-mail

Confirmation Email

6. Full Name

PrefixFirst NameLast Name

6. E-mail

Confirmation Email

7. Full Name

PrefixFirst NameLast Name

7. E-mail

Confirmation Email

8. Full Name

PrefixFirst NameLast Name

8. E-mail

Confirmation Email

TOTAL:

MEDIA:

Upload logo (.jpg or .png) - max size 1MB - for inclusion in conference materials

Upload a File

Would you like to submit an ad (static picture) or video for inclusion in the conference app?

Please insert video URL here

Upload company ad (.jpg or .png) - max size 1MB - for inclusion in conference app (must be square dimensions)

Upload a File

TOTAL DUE: ${total}

Please make check payable to: The Children's Healing Institute

Mail to:

2161 Palm Beach Lakes Blvd, Suite 212

West Palm Beach, FL 33409

Please share any questions or comments below:

Completion of this form is confirmation of your support as a sponsor of the event, as set out above. Upon receipt, The Children’s Healing Institute will send an invoice for payment of amount due if not included. Please note that sponsorships are non-refundable.

Signature

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.