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
Name
This field is for validation purposes and should be left unchanged.

2023 SPONSORSHIP FORM

Annual SCJMHS Conference

IRS Code Section 501(c)(3) Statement

Card Billing Information

Have questions?

Payment Options

Quick Links

Recent Sponsors