(Orthocarolina Research Institute, 2001 Vail Avenue, Suite 300, Charlotte, NC 28207;

SPONSORSHIP FORM

Please fill out the information, complete and return no later than September 16, 2016.
Platinum Sponsorship byAugust 1, 2016

(OrthoCarolina Research Institute, 2001 Vail Avenue, Suite 300, Charlotte, NC 28207; 704-323-3967 fax*)

36th Annual Oscar Miller Day Symposium –"Hip & Knee Replacement Surgery” presented by the OrthoCarolina Hip & Knee Center

Friday,September 30, 2016 (Sheraton Charlotte Hotel, Charlotte, NC )

SPONSORSHIP BENEFITS / PLATINUM SPONSOR
$25,000
/ GOLD SPONSOR
$10,000 / SILVER
SPONSOR $5,000 / BRONZE
SPONSOR/
EXHIBITOR$2,500
Logo on program (Deadline: 8/1/16)
Front cover:
Limited to Academic Institutions
Back cover:
Industry Sponsors / Logo Deadline:
August 1st

Invitations to Oscar Miller Day Faculty Dinner (Thursday evening)
All OrthoCarolina physicians and conference speakers are invited. / 4 invitations
/ 4 invitations
/ 2 invitations

Two (2) six-foot exhibit tables / Premier
location
/ Premier location

One (1) six-foot exhibit table / Subsidiary
location
/ Location based on availability

Name recognition on sponsorship signage and attendee packet / / / /
Name recognition on OrthoCarolina Research Institute (OCRI) website / / /

We commit to the following Sponsorship/Exhibitor Level (Please check all that apply)

 Platinum- $25,000

 Gold- $10,000

 Silver- $5,000

 Bronze/Exhibitor- $2,500

Sponsor Information Form

Company Name:______

Contact Name:______ Corporate Contact  Local Sales Contact

Address:______

City: ______State: ______Zip Code: ______

Phone: ______Fax: ______

Email: ______

If the contact information above is for the corporate office, please include the email address(es) for the local sales rep(s) that will be exhibiting at the event below so we can communicate event details.

Sales Rep Email: ______

Credit Card PaymentAccount Number

Visa

Master Card

AMEX

DiscoverExpiration Date: ____/____/____ CVV#______

Make all checks payable to:OrthoCarolina Research Institute (OCRI)

Mail to: OrthoCarolina Research InstituteContact: Caryn Thompson

2001 Vail Avenue, Suite 300 P: 704.323.2264/F: 704.323.3967

Charlotte, NC28207

We thank you in advance for any contributions you make to this year’s event!

100% of the net proceeds benefit the OrthoCarolina Research Institute, Inc and sponsorships are tax deductible (TIN: 01-0648145).