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Sponsor Registration Step 1: Company and Contact Information
Required Fields*
Company Name*
Specialty*  
Address*
Address Line 2*
City*
State*
Zip*
Phone*
Ext.

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Company Contact Name:*

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Contact Email*

Sponsor Package*
Purchasing Silver Sponsor Sponsor - $500

Purchasing Gold Sponsor Sponsor - $1000

Fill out Attendee Info only if you are purchasing a Gold Sponsor.
GOLD Sponsor Attendee Name**

FirstLast

Attendee Title**
Attendee Contact Email**




Merchant Services
May 9-10, 2019 Charleston, WV Online Conference Registration
SPONSORSHIP OPPORTUNITY You are invited to register as a sponsor for the 2017 West Virginia Workers’ Compensation Educational Conference. The following sponsorship levels are available: Silver: $500 Contribution • Organization name will appear on a large “Thank You Sponsor” sign in exhibit area. Gold: $1,000 Contribution • Complimentary Attendee Registration • Organization name and contact information will appear in conference program • Organization name will appear on a large “Thank You Sponsor” sign in exhibit area.