November 22, 2010

							Corporate, Event, Exhibiting, or Advertising Sponsor Application


Agency/Company Name (as it should appear on conference materials)


Point of Contact (name of person purchasing Monetary, Exhibiting or Advertising Sponsorship)

Title:


Street Address                           City                     State           Zip Code

Telephone                                Fax                      Email           Website


                                        Corporate Sponsor
___ $15,000 + Platinum Sponsor (includes free Prime Exhibit Space and Free Full Page Ad)
___ $10,000 Gold Sponsor         (includes free Premium Exhibit Space and Free Half Page Ad)
___ $5, 000 Silver Sponsor       (includes free Premium Exhibit Space and Free Quarter Page Ad)
___ $3,000 Bronze Sponsor        (includes free Standard Exhibit Space and Free Quarter Page Ad)
___ $1,000 Pewter Sponsor        (includes free Standard Exhibit Space and Free Business Card Ad)

Please submit your ad as a high resolution digital file on a CD with your application in JPEG, .PDF, .GIF,
.BMP, or .TIFF format or email to nancy.Greer@rehab.alabama.gov indicate what level of sponsorship
and ad size The deadline to submit your art work is August 15, 2011.


                                           Event Sponsor
_____ $5,000 Conference Registration Bags (Exclusive)
_____ $5,000 Closing Breakfast And Keynote Address (2 Sponsorships Available)
_____ $3,500 Opening Session & Keynote Address            (2 Sponsorships Available)
_____ $3,000 Lanyards (Exclusive)
_____ $2,500 Ice Cream Social (Exclusive)
_____ $1,500 Refreshment Station (6 Breaks/Sponsorships Available)

                                        Exhibiting Sponsor
Type of product or service for exhibit: ______________________________________________________
____________________________________________________________________________________
___$300 Commercial Exhibitor
___$200 Non-Profit/Not-for-Profit
___$100 Deaf/Hard of Hearing Artisan
Booth Price: $_______ x Total number of booths requested: _______ = $
Exhibitor Utility & Audio/Visual Order Form

Please Indicate If You Need To Purchase:

Quantity                            Item                          Advanced         Floor           Total
                                                                    Rate           Rate*
            110 volt, 20 Amp Standard Drop Cord                   $50.00         $75.00*
            All other Electrical Service 30+ amp, 208, etc.       Call – See #1 below
            High-speed Internet Connection*                       $75.00         $100.00*
            Public IP Address – see below.                        $125.00        $200.00
            Digital Telephone Line*                               $35.00         $50.00*
            Analog Telephone Line (limited quantity)**            $75.00**       $95.00*
            Six (6) outlet power strip                            $10.00         $15.00
            42” TV/DVD Player/Roll Cart Package                   $325.00        $400.00
            42” TV/ Roll Cart Package                             $275.00        $350.00
            DVD/VCR Combo Unit                                    $50.00         $75.00
            Draped Roll Cart (54” or 34”)                         $35.00         $50.00
                                                                             Total Charges

Conditions and Regulations
1. Engineer will need voltage, amperage & plug configuration for equipment to determine pricing.
   Contact the Event Manager.
2. * Late phone, internet or electrical lines may not be possible after exhibitor set up has commenced if
   exhibitor set up is extensive.
3. ** Analog telephone lines are in short supply. Orders must to be confirmed to guarantee service.
4. Public IP Addresses: Exhibitor assumes ALL firewall protection in conjunction with a Public IP
   address.
5. Advanced orders (and advance rates) must be received seven days prior to show dates.
6. Wall, column and permanent building utility outlets are not a part of booth space and are not to be
   used by exhibitors unless specified.
7. All equipment, regardless of source of power, must comply with all federal, state and local safety
   codes.
8. All equipment must be properly tagged and wired with complete information as to type of current
   voltage, phase, cycle, horsepower, etc.
9. All materials and equipment furnished for this service order shall remain RMHCC’s property and shall
   be removed only by RMHCC at the close of the show.
10. All exhibitors’ cords must be of the 3-wire grounded type.
11. Rates quoted for all connections cover only the bringing of service to the booth in the most
    convenient manner, and do not include connecting equipment and special wiring.
12. All food, beverage, audio visual equipment and room rental charges are subject to a taxable 20%
    service charge. The applicable sales tax on food, beverage and audio visual equipment is 10%. An
    occupancy tax of 12.5% is applied to meeting room rental charges.
                          Program Book Advertisement Sponsor
Please submit your ad as a digital file on a CD with your application in JPEG, .PDF, .GIF, .BMP, or .TIFF
format or email to nancy.greer@rehab.alabama.gov indicate what level of sponsorship and ad size. The
deadline to submit your art work is August 15, 2011.

___$1,000               OUTSIDE BACK COVER                               10.5” H x 8” W
___$750                 INSIDE BACK COVER                                9.8” H x 7.0” W
___$750                 INSIDE FRONT COVER                               9.8” H x 7.0” W
___$500                 FULL PAGE INTERIOR                               9.8” H x 7.9” W
___$350                 VERTICAL HALF PAGE                               9.8” H x 3.8” W
___$350                 HORIZONTAL HALF PAGE                             4.75” H x 7.9” W
___$200                 QUARTER PAGE                                     4.75” H x 3.8” W
___$100                 BUSINESS CARD HORIZONTAL                         2.25” H x 3.8” W
___$100                 BUSINESS CARD VERTRICAL                          3.8” H x 2.25” W


                                             PAYMENT
A 50% deposit is required to reserve your sponsorship. All payments must be made in full by
September 1, 2011. Payment in full with application is encouraged.
CANCELATION:
All cancellations must be made in writing. Due to contractual obligations, no refunds will be made
for cancellations received on or after September 1, 2011; a 60% refund will be granted for
cancellations made on or before August 15, 2011.

Send completed form and sponsorship registration form and money (check, money order, credit card) to:
SERID
Sponsorship Application
Attention: Shay Hicks
2125 East South Blvd.
Montgomery, Alabama 36116

____Corporate Sponsorship                amount enclosed:                        $
____Event Sponsorship                    amount enclosed:                        $
____Exhibiting Sponsorship               amount enclosed:                        $
____Advertising Sponsorship              amount enclosed:                        $
____Exhibitor Utility Audio/Visual Fee amount enclosed:                          $
____Digital Image on CD Enclosed
____ Proof of Non-profit Documentation Enclosed
                                                                     Total: $
Agreement:
The undersigned agrees to abide by SERID Monetary, Exhibiting and Advertising Sponsorship rules and
regulations.
Signature                                                        Title                                    Date
Credit Card Authorization Form
Please provide all the information requested below as a form of payment for all event charges as outlined.

Cardholder Information

Name as it appears on the credit card:

Card type:                   Visa          MC             Amex            Diners/CB           Discover      JCB

Account type:                Individual (personal credit card)     Amount __________

                             Corporate     Company Name:

Credit Card Account                                                                          Exp. date:
Number:

Address:
(where statement is
mailed)

City, State and Zip:

Phone number:                                                     Fax or alternate number:

Event Information

Name of Event:              Southeast Regional Institute on Deafness 2011 (SERID, INC.)

Organization Name           Southeast Regional Institute on Deafness

Event Dates:                Sat, Oct 15, 2011 to Wed, Oct 19, 2011


I certify that all information is complete and accurate. I hereby authorize the collection of payment for all
authorized charges associated with this event by processing a charge to the credit card listed above. I
certify that I am the authorized signer of the credit card listed above.

Cardholder name:
(Printed)

Cardholder signature:                                                               Date: