Statewide Conference
Sponsors and Exhibitors Form
Self-Advocates of Indiana, Inc.
Please print this page, or print this
form in PDF format, and
complete the information. Then mail the form with your check
made out to SELF-ADVOCATES
of Indiana to
the address below.
_____ I'd like to be a Sponsor of the 2006 statewide conference for people with developmental disabilities
and their supporters.____ Gold Sponsorship: $1000
____ Silver Sponsorship: $500
____ Bronze Sponsorship: $250
____ Friend of SAI: $25 - $125
____ Other:_______________
Self-Advocates of
Indiana, Inc. is a 501(c)3 organization.
Your sponsorship is tax deductible.
____ I’d like to be an Exhibitor
at the 2006 statewide conference
to be held at the Bloomington Convention Center.
Exhibitor fee: $150
Exhibition hours: Thursday, September 7, 2006
Set up: 8am
Exhibit: 9am – 4pm
Dismantle: 4pmThere is no exhibitor fee for Sponsors who contribute $1,000
or more. Exhibitors may sign up for lunch on Thursday.
The cost is $15 per person.Exhibit fee:_________ Lunch for ____ people
Your check total:_________
Please make checks payable to
Self-Advocates
of Indiana, Inc.
Name: ___________________________________________
Organization:______________________________________
Phone (day) ____________ Phone (evening) ____________
Address: _________________________________________
Email:____________________ Fax: ___________________
Please mail this form with your check to Maribeth Mooney,
IIDC-CAC, 2853 East 10th Street, Bloomington, IN 47408.
If you have any questions, you can call Maribeth at
812-856-5543 or toll free in Indiana: 800-825-4733.
Thank you!
