WMECC Vendors & Sponsors Please note – if there are multiple people from your organization and you would like to pay by check – you can do so. All checks need to be postmarked by May 31st in order for you to be registered for the conference. Agency Name * Agency Address * Agency Address Agency Address Agency Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Agency Representative Name * First Name Agency Representative Last Name * Last Name Agency Representative Email * Confirm Agency Representative Email * Agency Representative Phone * Business Address (if different from Agency Address) Business Address (if different from Agency Address) Business Address (if different from Agency Address) Business Address (if different from Agency Address) City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Agency Representative Date of Birth * Website/URL Sponsorship Package * -- Choose Your Sponsorship Package --Conference SponsorAfternoon Keynote SponsorDessert Sponsor(s)Hydration Station Sponsor(s)Parking Sponsor(s)Health and Wellness Sponsor Please select "Vendor Table Only" if you only wish to reserve a space as a vendor; all other packages will include a table as part of the package. Vendor Table Type * For-Profit Vendor Non-Profit Vendor As a sponsor you will be allowed 2 registration spots as part of your sponsorship. Will you be registering additional conference attendees? * Yes No Previous Attendee? Yes No Logo Upload: (File upload that allows the sponsor/vendor to upload their logo directly to us so that we can have a digital copy for the website and print) Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Photo Consent * By attending this event, you acknowledge and agree that photographs and video may be taken during the conference. These images and recordings may be used by the organizers for promotional and marketing purposes, including but not limited to social media, websites, and future event materials. Order Total $ Payment Method * Credit Card Check Credit Card You have opted to pay by check, please note that we will hold your request for sponsorship for 10 Days. If payment has not been received by then we will open the spot back up for another sponsor. Mail your check to:Mary-Anne SchelbJGS Lifecare770 Converse StreetLongmeadow, MA 01106 If you are human, leave this field blank. Next
