Emporia Area Chamber of Commerce and Convention & Visitors Bureau
January 2015
2015 Sponsorship Package Order Form
Return Form To The Emporia Area Chamber Of Commerce – 719 Commercial Street
CONTACT NAME: ___________________________ PHONE NUMBER: ___________________
ORGANIZATION/BUSINESS NAME: ________________________________________________
MAILING ADDRESS: ____________________________________________________________
EMAIL: ____________________________________________________________
Please Choose A Package Option Be low
_______ Mailroom Level @ $42.50 ($50 after Jan. 30, 2015)
_______ Entry Level @ $85.00 ($100 after Jan. 30, 2015)
_______ Professional Level @ $212.50 ($250 after Jan. 30, 2015)
_______ Executive Level @ $425.00 ($500 after Jan. 30, 2015)
_______ Sponsor An Event – Includes 15% Discount if purchased by Jan. 30, 2015.
If Sponsoring An Event:
Please indicate if you’d like to cover the cost of FOOD or ALCOHOL (circle one).
You are able to choose the local caterer or beverage provider of your liking. Deposit of $50 required for
EmporiaNext to secure Sponsorship and Month. Payment for food or alcohol made directly to vendor, with
full deposit going towards the cost.
Please choose three months, between Jan – Oct 2015, in which you would be willing to sponsor ONE.
FIRST CHOICE:
_______________________
SECOND CHOICE:
THIRD CHOICE:
_______________________
_______________________
Payment Options
______ Check enclosed (check number _____) Please make checks out to Emporia Area Chamber of Commerce.
______ Credit Card TYPE (CIRCLE ONE):
VISA
MASTERCARD
DISCOVER
AMERICAN EXPRESS
CARD NUMBER: _____________________________________
EXP DATE: _______ CVC CODE: ______ ZIP CODE: _________
SIGNATURE: ________________________________________
EmporiaNext Use Only:
Date Form Received: ___________________ Received by: ______________________
Payment Received: __________________
If Sponsoring An Event, which month: _______________ Sponsor Notified of Month? ___________
Logo Received: ___________
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