University Conference Publisher Sponsorship Form

Publisher/Company Name

Contact Person Full Name

First NameLast Name

Contact Email Address

example@example.com

Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Company Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Publisher Website

Brief Description of Your Publishing Activities

Select Sponsorship Level

Please select the promotional opportunities you are interested in:

Other (please specify)

Preferred Sponsorship Payment Method

Other (please specify)

Upload your company logo or promotional material (optional)

Signature of Authorized Representative