2016 Corporate Membership Application
**you may fill out this application and pay online at www.ncnga.org/corporate-members/**
Company Name___________________________________________________________________________ Contact ___________________________ E-mail Address_________________________________________ Company Address _________________________________________________________________________ City ________________ State _______________ Zip _____________ Telephone (______) ________________________ Fax # (______) _______________________ ____Yes, I would like to invest in a corporate membership with the North Carolina National Guard Association. Headline ($10,000)
Silver ($1500)
Diamond ($7500)
Bronze ($750)
Platinum ($5,000)
Exhibitor Space Only ($500)
Gold ($3000)
***If you will not be exhibiting at the convention, please check here
and skip this section.
Forms must be received by 1 April 2016. Exhibitors will have one table and 2 chairs. Move-in date: 29 April 2016
Move-out date: 30 April 2016
REQUIREMENTS: Please indicate if you will require any of the following: Sponsor Level: $_______ Additional Tables: Yes No $200.00 x ______ = $_______ Electrical Access (120V): Yes No $50.00 x ______ = $_______ Company Display: Table-top Floor Display Total: = My check in the amount of $__________ is enclosed, made payable to NCNGA. or Please charge my Corporate Membership in the amount of $_____________ to: *Note: A 3% processing fee for credit cards*
___________________________________________ ________________________________________________ Name on Card Credit Card Number ________________ Exp. Date
________ CVV
We agree to abide by the following: The exhibitor assumes the entire responsibility and liability for losses, damages, and claims arising out of exhibitor’s activities on the Hotel Premises and will indemnify, defend and hold harmless the Hotel, it’s agents, and employees from any and all such losses, damages, and claims.
_________________________________________ Authorized Signature
Please return this application along with the appropriate membership fee to: 2016 Convention Or Email to: katie@ncnga.org North Carolina National Guard Association Or Fax to: 919-859-4990 7410 Chapel Hill Rd Raleigh, NC 27607
_____________________________ Date
*A separate pre-registration form needs to be completed for those attending convention activities. That form will be sent once this application is received.