SPONSORSHIP REGISTRATION FORM Encompass Canada Technical Seminar Toronto – Tuesday, February 20, 2007 Montreal – Thursday, February 22, 2007 To register as a sponsor, advertiser, or contributor for the technical seminars, please print out the pages of this form, enter the necessary information, and fax the pages to: 709-834-7846 SPONSORSHIP LEVEL REQUESTED Please select Sponsorship Level to be registered: ____ Session Sponsor $800 ____ Service Sponsor (Breakfast) $500 ____ Service Sponsor (Lunch) $500 ____ Service Sponsor (Coffee Breaks) $500 ____ Advertiser $200 ____ Contributor $100 A discount to the sponsorship fee is available if you choose to sponsor both the Toronto and Montreal seminars. Please contact Anne at events@encompasscanada.org Detailed seminar sponsorship information is available at: http://www.encompasscanada.com/seminar-sponsorship.htm CONTACT INFORMATION Name of Contact: _______________________________________________________ Occupation or Title: _____________________________________________________ Company or Organization: _________________________________________________ Mailing Address: _______________________________________________________________ City/Town: ____________________ Province/State: ________ Postal/Zip Code: _________ Business Phone: _____________________ Cell/Alternate Phone: _______________________ FAX: ____________________________________________ E-mail: ___________________________________________ Alternate E-mail: ___________________________________ (continued on next page) PAYMENT INFORMATION SENDING CREDIT CARD INFORMATION VIA E-MAIL: Due to the security concerns of our Internet mail, credit card information should NOT be sent electronically. If you wish to pay by credit card but would like to submit your registration through our on-line registration form, you will need to phone in the information through the telephone number in the ‘Method of Payment’ section below as designated by Encompass Canada. Type of payment for sponsorship: Credit Card: ____ VISA ____ MasterCard ____ American Express Cheque/M.O.: ____ Company Cq ____ Personal Cq ____ Money Order P.O.: ____ Purchase Order (for government and other institutions) If you are paying by credit card, please enter your credit card information: Exact name as displayed on credit card: ___________________________________________ Credit card number: ______________________________ Expiry Date: _________________ Method of payment: ____ Telephone credit card info to: 416-371-0051 ____ Fax credit card info to: 709-834-7846 ____ Send cheque or money order by postal mail to: Technical Seminar Sponsorship Encompass Canada P.O. Box 13132, Station Topsail Conception Bay South, NL A1W 2K1 ____ Send invoice to: (if address is not the same as in Sponsorship Information) Name of Contact: _________________________________ Occupation or Title: ________________________________ Organization of Contact: ________________________________________________________ Mailing Address: ______________________________________________________________ City/Town: ____________________ Province/State: ________ Postal/Zip Code: _________ All sponsorship fees should be made payable to the order of Encompass Canada. The term of this agreement shall begin on date of signing and until April 30, 2007. I agree to participate as an event sponsor for the Encompass Canada and to the terms of the sponsorship agreement: Sponsor, Advertiser, or Contributor: ________________________________________ Name of Signatory: ____________________ Occupation or Title: ________________ Signature: ______________________________________ Date: _______________ PRESENTATION INFORMATION (Session Sponsor ONLY) Please complete this section only if you are participating as a Session Sponsor and would like make a presentation as part of the seminar agenda. Your presentation description and speaker biography must be submitted no later than February 12, 2007 in order for the information to appear on the seminar program. You can also e-mail your information to events@encompasscanada.org. Full Name of Speaker: ______________________________________ Title of Speaker: ___________________________________________ Speaker's E-mail Address: ___________________________________ Presentation Title or Subject: _____________________________________________________ Presentation subject or topic description: (max. 200 words) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Biography of speaker/presenter: (to introduce speaker in 100 words or less) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Audio-Visual Equipment Requirements: The seminar room will be equipped with a LCD projector to allow a slide presentation via notebook computer. Please indicate your A/V requirements: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Please send completed form with your payment by fax to: 709-834-7846 or postal mail to the contact information provided in the previous Payment Information page. Copyright 2007, Encompass Canada - An HP User Group - Updated: January 9, 2007