Keeping Our Eyes on the Prize: Independence! 2011 Annual Conference on Independent Livi

Sponsorship, Exhibit, and Advertisement Commitment Form

Company Name (as it will appear in printed materials): 
Contact Person: 
Title: 
Address: 
City, State, Zip: 
Email: 
Phone: 
Fax: 

Sponsorships

Revolutionary Level: $25,000
_1st Choice: 
_2nd Choice: 
_3rd Choice:  

Mover and Shaker Level: $10,000
_1st Choice: 
_2nd Choice: 

Activist Level: $5,000
_1st Choice: 
_2nd Choice: 
_3rd Choice:   
_4th Choice: 

__Catalyst Level: $1,000
__Upstart Level: $750 (CILs, SILCs and IL Associations only)
  

Exhibits

By May 6, 2011					
__$2,000 Corporate/For-Profit Group
$1,000 Nonprofit or Government Agency
$500 Member CIL, SILC or IL Association (NCIL members only)				   

After May 6, 2011
$2,250 Corporate/For-Profit Group	
$1,250 Nonprofit or Government Agency
$750 Member CIL, SILC or IL Association (NCIL members only)

Advertisements

By May 6, 2011					

__$1,500 Full-Page (8” x 10.5”)
__$850 Half-Page (8” x 5.25”)	
__$450 Quarter-Page (3.75” x 5.25”)

After May 6, 2011
__$1,650 Full-page (8” x 10.5”)
__$950 Half-Page (8” x 5.25”)
__$550 Quarter-Page (3.75” x 5.25”)

Special Ad Rates Exclusively for CILs, SILCs and IL Associations

By May 6, 2011					

__$900 Full-Page (8” x 10.5”)			
__$550 Half-Page (8” x 5.25”)			
__$200 Quarter-Page (3.75” x 5.25”)		

After May 6, 2011
__$1,000 Full-Page (8” x 10.5”)
__$650 Half-Page (8” x 5.25”)
__$250 Quarter-Page (3.75” x 5.25”)

Brochure Table

__$250: Display your organization’s brochure, flier or other promotional material on a special designated table in the registration area (must be available in all formats).


Payment Information

Please charge $ _________ to my:
__Visa
__MasterCard
__Discover
__American Express

Card Number: 
Expiration: 
Name as it appears on card: 
Signature: 

We prefer that you email your completed form to sponsor@ncil.org.  You may also fax your completed form: 202.207.0341. If you choose to mail your completed form, please send to:
NCIL 
Attn: Christine Boucher
1710 Rhode Island Avenue NW
5th Floor
Washington DC 20036

If paying by check, please make payable to National Council on Independent Living (Federal Tax ID: 74-2291620). Questions?  Please contact Christine Boucher via email: sponsor@ncil.org. Reminder:  Artwork must be sent by May 31, 2011 to Eleanor Canter at eleanor@ncil.org. 

Thank you for your support and commitment to NCIL!