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Sponsorship Form in US dollar- $

Organisation

Postal address, including city and province

Postal code

Country

Full name & surname

Email address

Work telephone

Country Code Number

Mobile

Country Code Number

VAT number

Logo and web details will be placed on the conference website - 500Kb max file size

 

Sponsorship Level

Bronze Level: between $200 and $900       

Silver Level: between $1000 and $2000     

Gold Level: between $2100 and $3000       

Platinum Level: between $3100 and $5000

Diamond Level: more than $5000                

Specify amount in Us dollar ($) :

 

Payment Method

Payment is only by bank or electronic transfer

All information provided will be handled with the strictest confidence. The organisers will not be responsible for identifying funds if the Institution names are not mentioned.
Costs for an international transfer will be for the sponsor's own account

Note an invoice will be emailed to the email address submitted on this form