SSSSSSAPPLICATION FOR CONFERENCE SPONSORS

Company___________________________________________________________________________

Contact Person___________________________________ Telephone () ) )  ) _____________________

Mailing Address______________________________________________________________________

City, State, Zip_______________________________________________________________________

Fax Number () ) )  ) _______________________ E-mail ______________________________________

Business Web Address: ________________________________________________________________

Directions: Please indicate your sponsorship or contribution level.

____dPlatinum Sponsor ($1000+)
____dGold Sponsor ($500-$999)
____dSilver Sponsor ($250-$499)
____dBronze Sponsor ($100-$249)
____dContributor (Less than $500)

Your sponsorship will be used to assist with the following conference expenses:

• Participant scholarships to attend the conference
• Conference promotion
• Refreshments, luncheon
• Conference speakers
• Facility Costs

Sponsorships may be adjusted to meet your organizational guidelines. If this is required, please contact Shakira Cain at 601-432-6151.

PAYMENT: PLEASE CHECK ONE

d____dCheck Enclosedrrrr____dPurchase Order Enclosedrrrr____dMoney Order Enclosed

Make all checks payable to JSU COLLEGE OF LIFELONG LEARNING. Please mail
completed registration form and check, purchase order, or money order to the address below:

Jackson State UniversityddddddddddddddddPhone: (601) 432-6234 or 1-800-264-6234
College of Lifelong LearningdddddddddddddFax: (601) 432-6124
3825 Ridgewood Road, Box 23
Jackson, MS 39211