AMTA Annual Workshop Sponsorship Registration – 10% Discount Opportunity Sponsorship Contact InformationSalutationMr.Mrs.Ms.Dr.First Name* Middle Initial Last Name* Suffix (i.e.: Ph.D., P.E., Jr.) Job Title* Company* Address* City* State/Province*Not Applicable, InternationalAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZip/Postal Code* Country*USAAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweTelephone* Cell Phone Email Address* Website Billing InformationEnter billing contact information, if applicableBilling Contact Name Billing Contact EmailEnter billing contact's email address, if applicable Billing Contact Phone Please send copy of the invoice/receipt to Billing Contact Company InformationCompany LogoAccepted file types: jpg, eps, png, pdf, gif, ai, Max. file size: 100 MB.Please provide a High Resolution, 300 dpi or greater.If you will be sending the logo separate, please email directly to custsrv@amtaorg.com.Company Description*Please provide one paragraph - 150 words or less. Sponsorship LevelBronze: ($600 x 4 Workshops = $2,400 @ 10% - $240) $2,160 Silver: ($800 x 4 Workshops = $3,200 @ 10% -$320) $2,880 Gold-A - includes one registration: ($1,200 x 4 Workshops = $4,800 @ 10% - $480) $4,320 Gold-B - includes a Table Top Package: ($1,650 x 4 Workshops = $6,600 @ 10% - $660) $5,940 Platinum-A - includes one registration: ($1,400 x 4 Workshops = $5,600 @ 10% - $560) $5,040 Platinum-B - includes a Table Top Package: ($1,850 x 4 Workshops = $7,400 @ 10% - $740) $6,660 Networking Event: ($2,000.00 to $6,000.00 per event @ 10% $800 – $2,400) $7,200 – $21,600 All sponsors will receive: • An e-mail list of attendees two weeks prior to the workshop and a final list once available • Acknowledgement in the attendee materials (a 100-word company description) • An opportunity to distribute a company promotional item to all attendees when they sign in • Printed recognition during the workshop • Recognition at the opening of each day and at the closing of the workshop • Logo or company name printed in the Workshop brochure if registered prior to publication. The size of the logo or company name will depend on space available and will reflect the level of sponsorship with Platinum and Gold Sponsor logos being the largest. AMTA's 2021 Workshop Schedule: • August 3rd-5th - Fargo, ND - AMTA/NWMOA Joint Tech Transfer Workshop • October 26th-28th - Houston, TX - AMTA/SCMA Joint Tech Transfer Workshop Additional recognition at the One-Day Workshop: • September 14 - Lancaster, OH - AMTA Tech Transfer Workshop Today - Date MM slash DD slash YYYY Sponsorship Level (10% Discount)* Bronze, $2,160 Silver, $2,880 Gold-A (one registration), $4,320 Gold-B (Table Top package), $5,940 Platinum-A (one registration), $5,040 Platinum-B (Table Top package), $6,660 Networking Event ($7,200 – $21,600), $0 If a company registers to sponsor all scheduled workshops in a given year, a 10% discount will be applied from the rate listed above. Full payment must be received on or before March 31st to qualify for the discount.Sponsorship Level (10% Discount)* Bronze, $2,160 Silver, $2,880 Gold-A (one registration), $4,320 Gold-B (Table Top package), $5,940 Platinum-A (one registration), $5,040 Platinum-B (Table Top package), $6,660 Networking Event ($7,200 – $21,600), $0 If a company registers to sponsor all 4 scheduled workshops in a given year, a 10% discount will be applied from the rate listed above. Full payment must be received on or before March 31 to qualify for the discount.Sponsor Networking Event* Networking Event ($2,000 x 4 = $8,000 @ 10% - $800), $7,200 Networking Event ($3,000 x 4 = $12,000 @ 10% - $1,200), $10,800 Networking Event ($4,000 x 4 = $16,000 @ 10% - $1,600), $14,400 Networking Event ($5,000 x 4 = $20,000 @ 10% - $2,000), $18,000 Networking Event ($6,000 x 4 = $24,000 @ 10% - $2,400), $21,600 Sponsor Networking Event* Networking Event ($2,000 x 4 = $8,000 @ 10% - $800), $7,200 Networking Event ($3,000 x 4 = $12,000 @ 10% - $1,200), $10,800 Networking Event ($4,000 x 4 = $16,000 @ 10% - $1,600), $14,400 Networking Event ($5,000 x 4 = $20,000 @ 10% - $2,000), $18,000 Networking Event ($6,000 x 4 = $24,000 @ 10% - $2,400), $21,600 Total $0.00 Payment InformationPayment Method* Credit Card - Online Payment eCheck (Bank Wire w/o processing fee) - Online Payment Check Invoice Full payment must be received on or before March 31st to qualify for the discount.If paying by check, make payable to: American Membrane Technology Association1811 Englewood Rd., #280Tallahassee FL, 32317 Comments/QuestionsComments/Questions CAPTCHACAPTCHAPlease refer to AMTA’s Privacy Policy if you have any questions regarding your preferences.