Forum 2012

Sponsorship Registration Form

FAX your completed form today!

Send to 1.202.729.6756
INFORMATION

First Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
Last Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
As you wish to appear on your name tag at the forum

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Nonmember nonprofit
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Government
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Tel
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Registration confirmation will be sent via email

BE A SPONSOR AT THE INTERACTION FORUM

Corporate/Government Nonmember Nonprofit
Diamond ($100,000)
Diamond ($90,000)
Platinum ($75,000)
Platinum ($60,000)
Gold ($50,000)
Gold ($40,000)
Silver ($25,000)
Silver ($20,000)
Bronze ($15,000)
Bronze ($10,000)

InterAction Member
Diamond ($80,000)
Platinum ($50,000)
Gold ($30,000)
Silver ($15,000)
Bronze ($5,000)

InterAction Scholarship Fund

Please designate 10% to InterActions Scholarship Fund
New this year, you will have an opportunity to designate 10% of your
sponsorship for InterActions scholarship fund. InterAction will use
the funds to assist both young professionals with a career interest in
international development, and InterAction member staff from the Global
South to attend Forum 2012.
Please indicate your preference for booth location/tabletop location:

1st_____________2nd_____________3rd_____________

ADVERTISING OPPORTUNITIES
Advertise in the Forum 2012 Program

1/4 Page ($500)

1/2 Page ($750)
Full Page ($1000)

Advertise in Monthly Developments

1/4 Page ($915)

1/3 Page ($1090)
1/2 Page ($1315)
Full Page ($2175)

Note: Complimentary advertising space in Julys Forum-recap issue of

Monthly Developments is included in some sponsorship packages, but
sponsors may also wish to purchase additional advertising in the May issue
that will be distributed at the Forum itself. A discount is offered if you choose
to run in multiple issues of Monthly Developments throughout the year.

MEALS & FUNCTIONS

The following meals are includued in your complete forum registration.

Monday, April 30

Tuesday, May 1

Wednesday, May 2

Exhibitor registration deadline is April 13.

Cancellations must be submitted by email
to forum@interaction.org by April 16.

Networking Luncheon
Plenary Breakfast
Exhibit Hours Breakfast
Need extra tickets?
Exhibit/Happy Hour
Plenary Luncheon
Closing Plenary Luncheon
GALA PLENARY & AWARDS BANQUET

Gala Reception
Full Table (9 Additional seats for $800)

Gala Dinner
Additional Seat
SPECIAL ACCOMMODATIONS

I prefer vegetarian meals
I have special needs as follows:
Tickets are $100 each. How many? ____
___________________________________________________
___________________________________________________ TOTAL $ ___________
Full Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ Full Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
ADDITIONAL
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FULL CONFERENCE Title
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REGISTRATION

BOOTH PERSONNEL PASSES

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Last Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _

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First Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
Last Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _

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There will be $20 charge for each additional booth personnel. Please include in your total payment.

PAYMENT INFORMATION

VISA Master Card American Express

Card Holders Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _

Credit Card Number _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _

Expiration Date ____/____/______
Card Holders Signature ________________________
Date
____/____/______

Make checks payable to InterAction

Be sure to write EXHIBITOR PROGRAM in the memo field. Send payments to:

InterAction, Attn: Forum Registrar

1400 16th Street, NW, Suite 210
Washington, DC 20036 USA
Tel: 1.202.667.8227