2016 Entrepreneurial Insurance Symposium EIS Brochure | Page 13

Sponsorship Opportunities SPONSORSHIP AGREEMENT & SELECTION FORM - PART I Thank you in advance for participating in the 2016 Entrepreneurial Insurance Symposium! MarketScout will send each sponsor a signed copy of this contract acknowledging acceptance and specific sponsorship benefits according to the prior pages of this document. Please check all sponsorships that apply: Innovation Partner - Email [email protected] Platinum - $15,000 Gold - $10,000 Silver - $5,000 Bronze - $3,000 Evening Networking Reception - $12,500 Opening Day Breakfast - $10,000 Power Charging Station - $4,000 Refreshment & Beverage Breaks - $2,500 Networking Exhibit Mall - $1,600 CIC update registration ($420 per attendee) $ ________________________________ Grand Total Due for Sponsorship Please make checks payable to MarketScout. $ ________________________________ I hereby make application for the above sponsorship(s) for the 2016 Entrepreneurial Insurance Symposium. Company Name: _________________________________________________________________________________ Contact Name: ________________________________ Title/Position: ____________________________________ Mailing Address: _________________________________________________________________________________ City: ________________________________________ State: ______________________ Zip: ____________________ Phone: ________________________________________ Fax: ______________________________________________ E-mail: ____________________________________________ Website URL: _________________________________ Please send completed Sponsorship Agreement & Selection Forms Part I & II to Diahann Doyen by fax at [phone] or email at [email protected]. You will receive confirmation once your sponsorship has been approved. Sponsorships are assigned on a first-come, first-served basis and are non-refundable. Tel: [phone] Email: [email protected] www.eInsuranceSymposium.com