LASE/LASS PARTNERSHIP FORM

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					    LASE/LASS PARTNERSHIP FORM - 2012
Company Name _________________________________________
Primary Contact
Name/Title _____________________________________________________________
e-mail __________________________________________Fax____________________
Mailing Address _________________________________________________________
______________________________________________________________________
Office Phone _____________________Cell Phone _______________________


Secondary Contact (optional)
Name/Title _____________________________________________________________
e-mail __________________________________________Fax____________________
Mailing Address _________________________________________________________
______________________________________________________________________
Office Phone ________________________Cell Phone __________________________
Please indicate below the partnership level at which you would like to participate.

Partnership      LASE Only                LASS Only                LASE & LASS
Level            Partnership              Partnership              Partnerships

Platinum         $4,000 ________          $4,000 ________          $6,000 ________
Gold             $2,000 ________          $2,000 ________          $3,000 ________
Business         $1,000 ________          $1,000 ________          $1,500 ________
Exhibitor        $ 350 ________           $ 600 ________           $ 900 ________
Networking       $ 325 ________           $ 550 ________           $ 800 ________
Contributor      $_____________           $_____________           $_____________

Event Partnership – If you care to sponsor or co-sponsor a conference event in
addition to your partnership, please contact J. Rogers Pope at jrpope@cox.net, 225-
791-0365 (office) or 2225-572-8996 (cell).

              LASS Conference - June 10-12, 2012
              LASE/LASS Joint Conference - November 11-13, 2012
Exhibit Space – Each 6’ X 10’ space will be provided with an 8-foot backdrop, a three-
foot side drape, two chairs, a skirted table and 5 amps electrical outlet. Exhibits may be
set up the evening prior to the display date. The hotel will not provide security.
       Important - Exhibit space will be assigned on a first-come, first-served basis.
       Please return this form and a check made payable to LASE or to LASS to the
       address below.
       LASE/LASS
       J. Rogers Pope, Executive Director
       Post Office Box 40217
       Baton Rouge, Louisiana 70835-0217

Due Date - Monday, April 9, 2012

				
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