Problem Gambling Network of Ohio : Events : Additional Event Info : Conference Sponsors

Sponsor & Exhibitor Prospectus

Name

First Name *

Last Name *

Organization

Address

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Phone

Email (Required)

Sponsor Levels

Select one:

Gold (organization/corporation) $5000
Gold (non-profit/government) $3500
Silver (organization/corporation) $2500
Silver (non-profit/government) $1700
Bronze (organization/corporation) $1750
Bronze (non-profit/government) $1250

Sponsorship A La Carte

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Check all that apply:

Payment Option

Pay Now
Pay Later

Select a Payment Method

Credit Card
Bank Account

Cardholder Name (Required)

Credit Card # (Required)

Visa MasterCard American Express Discover

Expiration Date (Required)

Security Code (Required)

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Cover the fee associated with this online transaction?

Yes, I will pay an additional {transaction_fee} to cover the cost of this transaction.

Cover the fee associated with this online transaction?

Account Holder

First Name

Last Name

Account Type

Checking
Savings

Account Number (Required)

Routing Number (Required)

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Subscribe to our email newsletter?

Yes, I want to subscribe to your email newsletter.

For questions or additional information, contact Derek Longmeier at DLongmeier@PGNOhio.org or 614.750.9899.

Downloadable Sponsorship Application