2023 SPONSORSHIP FORM

Annual SCJMHS Conference

41 st Annual South Central Joint Mine Health and Safety Conference on April 3 – 5, 2023

Company Name:*
Company Address*
Street Address Address Line 2 City State ZIP Code
Primary Person (Point of Contact):*
First Last
Email*
Phone*
Company Description and Services*
Please provide a brief description of services and / or products the company offers as soon as possible to post to our “2023 LIST OF SPONSORS" webpage-
NOTE: The SCJMHSC Association is legally established under the laws of Texas as a non-profit organization, donations to help fund it are tax-exempt under IRS Code Section 501(c)(3). Each sponsoring organization or individual will receive a copy (if requested) of the Conference Association’s IRS Form W-9 for tax reporting (charitable donation deduction) purposes.
Sponsorship Levels are as follows:*
Please select level for participant registration information:
$5000 Diamond Level (Includes 5 paid participant registrations and company bio displayed on our website)
$4000 Diamond Level (Includes 4 paid participant registrations and company bio displayed on our website)
$3000 Platinum Level (Includes 3 paid participant registrations and company bio displayed on our website)
$2000 Platinum Level (Includes 2 paid participant registrations and company bio displayed on our website)
$1000 Gold Level (Includes 1 paid participant registration, and company bio displayed on our website)
$500 Silver Level (Includes company name ONLY recognized in the printed program)
$250 Bronze Level (Includes company name ONLY recognized in the printed program)
Participant #1
First Last
Participant #2
First Last
Participant #3
First Last
Participant #4
First Last
Participant #5
First Last
IRS Code Section 501(c)(3) Statement
The SCJMHSC Association is legally established under the laws of Texas as a non-profit organization, donations to help fund it are tax-exempt under IRS Code Section 501(c)(3). Each sponsoring organization or individual will receive a copy (if requested) of the Conference Association’s IRS Form W-9 for tax reporting (charitable donation deduction) purposes.
Select Level For Payment*
Please select level that matched your requested level above for payment.
Total
$0.00
Card Billing Information
Credit Card*
Card Details
Cardholder Name
Comments
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2023 SPONSORSHIP FORM

Annual SCJMHS Conference

IRS Code Section 501(c)(3) Statement

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