NACUSO Network Payment Form

Organization Name*

Print company name exactly as it should appear in all printed materials (e.g. in all caps, or abbreviated, etc).

Name of Person Submitting Payment*

First Last

Phone*

Email*

Membership or Post-Conference Balance Due: Select Item to Pay

Exhibitors: Shipping/AV/Equipment Fees
Private Meeting/Receptions: Food & Beverage/AV/Miscellaneous
Members/Attendees: Outstanding Balance Due

Enter payment amount for:

Exhibitors: Shipping/AV/Equipment Fees

Enter payment amount for:

Attendees: Outstanding Conference Registration Balance Due

Enter payment amount for:

Private Meeting/Receptions: Food & Beverage/AV/Miscellaneous

For 2022 Orlando Exhibitors: Select Sponsor Level

Diamond Level - $8,500
Emerald Level- $6,500
Sapphire Level - $4,500

For NACUSO Gold Partners (50% partner discount applied)

Diamond Level - $4,250
Emerald Level- $3,250
Sapphire Level - $2,250

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 / Money Order

Card Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card*

American Express

MasterCard

Visa

Card Number 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

Name

This field is for validation purposes and should be left unchanged.

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