Company     
Contact:       
Address:      
City:             State:Zip:
Phone:               Fax:
Email:              

Choose your Sponsorship Level
     Platinum * “Key to Quality” Awards Banquet Sponsor $15,000
     Gold * Keynote Speaker Sponsor $10,000
     Silver * Entertainment Sponsor $ 5,000
     Bronze * Afternoon Break Sponsor $ 2,500
     Exhibitor only $ 600
Grand Total $

(* Any sponsor level wishing to Exhibit, your booth fees are included in your sponsorship)
Payment options: (Please make checks payable to NAHCA)

Payment Method Select Card Visa MasterCard Check or Money Order
Card Number: Expires
Card Holders Name:
Address:
City StateZip