Corporate Sponsorship Form

Contact Information

Company Name*

Contact Person*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Enter Email Confirm Email

Please provide a method to contact you in the event of a problem with uploading your corporate logo. A confirmation email will be sent. Duplicate email addresses are not accepted.

Phone*

Corporate Sponsorship

Corporate Sponsorship is for one calendar year. Corporate Sponsorship includes:

1. the cost of your booth at the CTSRC Super Symposium in May 2018.

2. your company's logo will appear on our website, with acknowledgement of your company as a corporate sponsor.

3. acknowledgement of sponsorship on all symposium and fall printed conference advertising, and verbal recognition at the beginning of each day of the symposium and conference.

Corporate Logo

Please upload your corporate logo here

Corporate Sponsorship

Corporate Sponsorship $1200.00

Total

$0.00

Payment Options

When you click PURCHASE NOW, you will be directed to the PayPal site to complete your transaction.Payment can be made using a Pay Pal account OR credit card.

Check payment

Checks must be mailed to:

CTSRC

c/o Dan Oliva

47 Mustang Dr

Shelton, CT 06484-5420

Once your check has been received, your logo will be added to the site.

Phone

This field is for validation purposes and should be left unchanged.

Corporate Sponsorship Form

Contact Information

Corporate Sponsorship

Checks must be mailed to:

CTSRC c/o Dan Oliva 47 Mustang Dr Shelton, CT 06484-5420

Once your check has been received, your logo will be added to the site.

CTSRC

c/o Dan Oliva

47 Mustang Dr

Shelton, CT 06484-5420