Conference Sponsorship Form Sponsorship LevelsSuper Advocate Sponsor – $2,500+ Please enter an amount $2,500 or greaterGold Sponsor – $1,000 - $2,499 Please enter an amount between $1,000 and $2,499Silver Sponsor – $500 - $999 Please enter an amount between $500 and $999Bronze Sponsor – $250 - $499 Please enter an amount between $250 and $499Friends of GMSA Sponsor Please enter an amount up to $249Name(Required) First Last Organization/Business Sponsorship Ad Copy(Required)What would you like it to say in the program next to your name? File UploadMax. file size: 8 MB.Please upload a high quality JPEG file of your logo (or a photo you would like us to use instead of a logo). Alternatively, email to conference@gmsavt.org. Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Total Credit CardCard Details Cardholder Name Questions? Please call Max Barrows at 1-802-229-2600I'm not a robotNameThis field is for validation purposes and should be left unchanged. Δ
