DONATION / DISPLAY FORM

32ndAnnual
Developmental Disabilities Conference
KelloggCenter, East Lansing, MI

April 19-20, 2016

/ WMU Homer Stryker M.D School of Medicine
Office of Continuing Education
1000 Oakland Drive, Kalamazoo, MI 49008-8034
Phone: (269) 337-4305
Fax: (269) 337-6268

Company / Organization Name
As it will appear on conference material
Contact Person / Name of Representative who will be attending
Address
City State Zip
Phone E-Mail
Name and E-Mail for Second Display Attendee

I would like to provide support for this conference by means of:

Display fee of $400.00 (Call about rates for non-profit organizations and companies run by individuals with disabilities. Table sharing is also available for these organizations.)

-OR-

Brochure Only fee of $100.00 (Brochures will be included in attendee packets, estimated attendance: 500.)

 I would like to upgrade my sponsorship of this conference:

Not at this time

With a donation of $______for a total (including display fee) of $______

Payment is:

Enclosed. (If paying by credit card, please complete the payment form on page 3.)

Will be mailed at a later date.

If You Plan To Display At The Conference, Please Check This Box 

One 8’ table and two chairs will be provided. Do you need anything else, such as electrical outlets, etc?

Return this form by January15, 2015 if you would like your company listed in the conference brochure!
  • Our Tax ID Number is 45-4135256
  • Mail checks to WMed, DD Conference,
PO Box 50391, KalamazooMI49005-0391 /
  • Platinum Sponsorship $5000 or more
  • Gold Sponsorship $2000 or more
  • Silver Sponsorship $1000 or more
  • Bronze Sponsorship $500 or more
  • General Sponsorship $400

What’s Included?

Displays:

  • Displays may be set up anytime after 6:00am.
  • Breakfasts, lunches, and refreshments for two (2) people per day are included in the display fee. Additional display attendees will be charged a full registration fee.
  • You may attend the conference workshops, schedule will be published in January, pre-registration for workshops may be required.
  • Lodging is not included in the exhibit fee. Visit our website for the hotels where we have reserved blocks of rooms.
  • You may include a brochure in each attendee packet. Brochures must be received at least two weeks prior to the conference.

Brochure Only:

  • A copy of your brochure will be included in each attendee packet.
  • Brochures must be received at least two weeks prior to the conference.

For more information about the conference, visit our website at med.wmich.edu

Thank you for your support of this program

DONATION / DISPLAY PAYMENT FORM

32nd Annual
Developmental Disabilities Conference
KelloggCenter, East Lansing, MI

April 19-20, 2016

/ WMU Homer Stryker M.D. School of Medicine
Office of Continuing Education
1000 Oakland Drive, Kalamazoo, MI 49008-8034
Phone: (269) 337-4305
Fax: (269) 337-6268

Credit Card NumberExp.
Name on Card
Billing Address
City State Zip