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 firstname.lastname@example.org. Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 robotPhoneThis field is for validation purposes and should be left unchanged.