KnowledgeConnex

All questions marked by an asterisk are required

Event Name:

PHIMA | 2023 Corporate Sponsorship

*Company:

Contact Information

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip/Postal Code:

*Phone Number:

{xxx-xxx-xxxx}

*Email Address:

*Retype Email Address:

Website:

Company Description:

Company Logo:

Corporate Sponsorship

Sponsorship Level:

Bronze Corporate Sponsorship - $100.00
Silver Corporate Sponsorship - $1,000.00
Gold Corporate Sponsorship - $2,000.00
[Click here to clear selection for question above]

Acceptance of Terms and Conditions

I have reviewed and acknowledge acceptance of the terms and conditions which includes the insufficient check funds policy and credit card terms and conditions.

*Terms:

I accept the terms and conditions

Payment

Customer Code:

*Method of Payment:

Pay by Check
Credit Card

Save Information:

{Checking this option will save your information for future registrations}