PERSONAL INFORMATION
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REGISTRATION CATEGORY:
Category
Till
May 10th Sun – 11:59 PM PST
Until
April 1, 2017
After
April 1, 2017
Numbers
Amount
Adults- VPA Members/Relatives
$
195
$
195
$
225
$
Adults- Non Members/Guests
$
245
$
225
$
250
$
Children (7 – 12 years)
$
120
$
150
$
150
$
International Students
$
150
$
125
$
125
$
Continuing Medical Education(CME)
$
150
$
125
$
125
$
Socializing (25 yrs. and above)
$
25
$
25
$
25
$
Generous Donations
$
Registration Total:
$
0
Would you like to Pay for VPA Membership ?
Yes
No
Select Region
Select
MidWest
South
West
East
VPA Membership :
Membership Type
Amount
Total
Grand Patron
$
5000
$
Patron
$
1000
$
Life Time
$
500
$
2017 Family Member per year
$
40
$
2017 Single Member per year
$
20
$
Membership Total:
$
0
SPONSORSHIPS (Tax Deductible*):
Grand Sponsor
$
10,000
VIP check-in; 3 rooms for 3 nights; 6 registrations. Front row reserved seating - 1 Front or back inside page color Ad. - Felicitation on stage - Welcome gift
Platinum Sponsor
$
5000
VIP check-in; 2 rooms, for 3 nights; 6 registrations. Front row reserved seating - 1 full page color Ad. - Felicitation on stage - Welcome gift
Diamond Sponsor
$
3500
VIP check-in; 1 room for 3 nights; 4 registrations. Reserved seating. 1 full page color Ad. – Recognition - Welcome gift.
Gold Sponsor
$
2500
VIP check-in; 1 room for 3 nights; 4 registrations – Half page color Ad. – Welcome gift.
Bronze Sponsor
$
700
Complimentary Registration for 2
None
Sub Total:
$
0
MAGAZINE SPONSORSHIPS :
Full Back Page - Color
$
6000
Full Inside Front Page – Color
$
5000
Full Inside Back Page – Color
$
5000
Full Page - Color
$
1500
Half Page - Color
$
750
Full Page – Black & White
$
500
Half Page - Black & White
$300
Quarter Page - Black & White text only
$400
Full Page Co memorial
$1000
None
Magazine SponsorShip Total:
$
0
Service Charge:
$
0.00
Grand Total:
$
0.00
Payment
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6
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YYYY
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2017
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2019
2020
2021
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2024
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2026
2027
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2029
2030
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2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
CVV Number
Check Information
(Check should reach the team within 7 days of completing online registration to ensure that the registration is valid)
Check Payable to
VPA Convention 2017
Mailing Address
VPA Convention 2017, 1302 Bridle Blvd, Frisco, TX 75034
Check No
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