Sign up as a Sponsor / Vendor

Required fields are indicated with an asterisk (*)

Name & Address

* First Name

* Last Name

* Company / Organization

* Address

Addt'l Address

* City

* State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland & Labrador North Carolina North Dakota Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Not Applicable

* Country Albania Algeria American Samoa Angola Anguilla Antarctica Antigua/Barbuda Argentina Armenia Aruba Australia Austria Azerbaidjan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Falkland Islands Fiji Finland Former Czechoslovakia Former USSR France France (European Territory) French Guyana French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe (French) Guam Guatemala Guinea Guinea Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Islamic State of Afghanistan Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Cambodia Kiribati Kuwait Kyrgyz Republic (Kyrgyzstan) Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique (French) Mauritania Mauritius Mayotte Mexico Micronesia Moldavia Monaco Montserrat Morocco Mozambique Myanmar N. Mariana Islands Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia (French) New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Polynesia (French) Portugal Principality of Andorra Puerto Rico Qatar Reunion (French) Romania Russia Rwanda S. Georgia & S. Sandwich Isls. Saint Helena Saint Kitts & Nevis Anguilla Saint Lucia Saint Pierre and Miquelon Saint Tome (Sao Tome) and Principe Samoa San Marino Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St.Vincent & Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Tadjikistan Taiwan Tanzania Thailand The Democratic Republic of the Congo Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay USA Minor Outlying Islands Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (British) Virgin Islands (USA) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe

* Zipcode

* Phone Number

* E-mail If you supply an e-mail address, a receipt for your registration will automatically be sent to that account. An e-mail address is required to pay using a credit card.

Registration

To learn more about the varying sponsor and vendor options, visit the Michigan Onsite Wastewater Conference sponsor and vendor opportunities page.

I would like to register for *

Sponsorship Options Lunch Sponsor ($4,000.00) (2 openings available) Reception Bar Sponsor ($2,500.00) (1 opening available) Keynote Speaker Sponsor ($2,000.00) (1 opening available) Reception Sponsor ($1,500.00) (2 openings available) Breakfast Sponsor ($750.00) (2 openings available) Program Sponsor ($400.00) (1 opening available) Parking Sponsor ($300.00) (10 openings available) Audio Visual Sponsor ($250.00) (8 openings available) Vendor Space Vendor Space Only (1 booth with 1 representative receiving a full conference registration) ($425.00) Vendor Space Only with Electricity (1 booth with 1 representative receiving a full conference registration) ($450.00)

A standard vendor space includes one table and two chairs. Electricity is available for an additional charge.

Additional Registrations

Additional Booth Spaces without Electricity ($425.00) Each additional booth space comes with one additional complimentary registration.

Additional Booth Spaces with Electricity ($450.00) Each additional booth space comes with one additional complimentary registration.

Please indicate the number of additional full conference registrations needed ($250.00) A vendor registration only includes the booth space and 1 person. All additional attendees must register.

Additional Registrations: Please provide the names and emails of any additional registrants. Indicate their registration type as well. Ex. Full Registration - Joe Miller, noreply@msu.edu; Single Day (Tuesday) - Sue Smith, noreply@msu.edu

Special Dietary Needs: If you indicate an allergy, please specify if it's ingested or airborne. Please provide as much information as possible about your restrictions so that we can appropriately meet your needs.