NACUSO Network Exhibit Sponsor Signup Payment Form Organization Name*Please list the company name exactly as it should appear in all printed materials (e.g. in all caps, or abbreviated, etc). Contact Person (for pre-planning coordination)*Please provide the name of the person who should receive all of the pre-planning communication for exhibit logistics. First Last Phone* Email* Optional: Name of Secondary Contact Person (for pre-planning coordination)Please list name of additional person who should receive any communication for exhibit logistics. First Last Phone Email Select 2023 Networking Exhibits Lounge Sponsor PackageSelect a sponsor level. For Diamond and Emerald packages, please indicate from the drop box below, your first and second choices for a sponsored event. If you are a Gold Partner, please skip this and go to the next section to select your exhibit package. Refer to the NACUSO Network Exhibit Package Information if you need details on each package. None Exclusive Platinum or Gold Partner Special Event Option – $10,000 Platinum Partner Comped Exhibit Space – 0 Waitlist Request Diamond Level – $8,500 Emerald Level – $6,500 Sapphire Level – $4,500 Platinum Partner Special – $4,000 For NACUSO Gold Partners (some Diamond and Emerald packages are not included at 50% off).Please select the sponsor level. Unless noted, Gold Partners receive half-off the regular package prices. For Diamond and Emerald packages, please indicate from the drop box below your first and second choices for a sponsored event. Refer to the NACUSO Network Exhibit Package Information if you need details on each package. None Diamond Level (50% off) – $4,250 Diamond Level (for non discounted packages) – $8,500 Emerald Level (50% off) – $3,250 Emerald Level (for non discounted packages)- $6,500 Sapphire Level (50% off) – $2,250 1st Choice of Desired Diamond EventEvent Registration System Attendee Pocket AgendaSOLD OUT! Attendee BadgesConference Printed GuideSOLD OUT! Monday Wynn Golf Outing (not eligible for 50% discount)SOLD OUT! Monday Cocktail Station during Reception (not eligible for 50% discount)Tuesday Cocktail Station during Reception (not eligible for 50% discount)Wednesday Cocktail Station during Reception (not eligible for 50% discount)2nd Choice of Desired Diamond EventEvent Registration System Attendee Pocket AgendaSOLD OUT! Attendee BadgesConference Printed GuideSOLD OUT! Monday Wynn Golf Outing (not eligible for 50% discount)SOLD OUT! Monday Cocktail Station during Reception (not eligible for 50% discount)Tuesday Cocktail Station during Reception (not eligible for 50% discount)Wednesday Cocktail Station during Reception (not eligible for 50% discount)1st Choice of Desired Emerald EventSOLD OUT! Registration Welcome Branded Treat (not eligible for 50% discount)SOLD OUT! Networking Lounge Charging StationSOLD OUT! Water Bottle Station SponsorGiveaway of a Two-Night Hotel Stay Certificate (1 available)Giveaway of a $500 Mastercard Gift Card (2 left)SOLD OUT! Monday's New Attendee Welcome/Orientation General SessionSOLD OUT! Monday's Hot Topics for CUs & CUSOs in 2023 General SessionSOLD OUT! Tuesday BreakfastSOLD OUT! Tuesday Refreshment Break Morning Juice BarSOLD OUT! Tuesday Refreshment Break Treat StationSOLD OUT! Tuesday LuncheonSOLD OUT! Tuesday Hospitality Reception Dessert Bar StationSOLD OUT! Wednesday CUSO Awards PresentationSOLD OUT! Wednesday General Session: Regulatory SessionSOLD OUT! Wednesday BreakfastSOLD OUT! Wednesday Refreshment Break Morning Juice BarWednesday Refreshment Break Treat StationSOLD OUT! Wednesday LuncheonWednesday Hospitality Reception Dessert Bar Station2nd Choice of Desired Emerald EventSOLD OUT! Registration Welcome Branded Treat (not eligible for 50% discount)SOLD OUT! Networking Lounge Charging StationSOLD OUT! Water Bottle Station SponsorGiveaway of a Two-Night Hotel Stay Certificate (1 left)Giveaway of a $500 Mastercard Gift Card (2 left)SOLD OUT! Monday's New Attendee Welcome/Orientation General SessionSOLD OUT! Monday's Hot Topics for CUs & CUSOs in 2023 General SessionSOLD OUT! Tuesday BreakfastSOLD OUT! Tuesday Refreshment Break Morning Juice BarSOLD OUT! Tuesday Refreshment Break Treat StationSOLD OUT! Tuesday LuncheonSOLD OUT! Tuesday Hospitality Reception Dessert Bar StationSOLD OUT! Wednesday CUSO Awards PresentationSOLD OUT! Wednesday General Session: Regulatory SessionSOLD OUT! Wednesday BreakfastSOLD OUT! Wednesday Refreshment Break Morning Juice BarWednesday Refreshment Break Treat StationSOLD OUT! Wednesday LuncheonWednesday Hospitality Reception Dessert Bar StationOptional: Any notes or questions to the NACUSO Team?Total $0.00 Select Payment Option*For Check Payments – Mail to: NACUSO, Attn: Events Team, 6000 28th Street SE #300, Grand Rapids, MI 49546 Credit Card Check Card Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Credit Card* American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name You have elected to pay by check. Please print the next page or your confirmation email, and send it along with your check or money order payable to NACUSO, to: NACUSO 6000 28th Street SE, Suite #300 Grand Rapids, Michigan 49546 EmailThis field is for validation purposes and should be left unchanged.
