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.

____dDiamond Sponsor ($6000 +) includes full page ad and 10 participant admissions
____dPlatinum Sponsor ($4000-$5999) includes full page ad
____dGold Sponsor ($2001-$3999) includes 1/2 page ad
____dSilver Sponsor ($1000-$2000) includes 1/4 page ad
____dBronze Sponsor ($500-$999)
____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
• Conference reception

Conference sponsorships may be adjusted to meet your organizational guidelines.
If this is required, please contact Will Jones at 601-432-6234.

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