Register or Sponsor Now

2012 INCMA Legislative Conference Registration Form
$120 per attendee

Attendee 1 *

First

Last

Company *

Phone *

Email *

Attendee 2 *

Attendee 2 Company *

Attendee 3 *

Attendee 3 Company *

Attendee 4 *

Attendee 4 Company *

Would you like for INCMA to set up a lunch meeting with your legislator(s)? *

Yes No

Preferred Legislator? (If no name or names, please list your 9 digit zip code) *

Would you like to Sponsor this event? $500 *

Yes No

Please note that sponsorship includes:
- Opportunity to introduce one of our speakers
- Free Newsletter sponsorship page and website posting (value = $175);
- Recognition on all solicitations;
- Recognition in INCMA’s monthly fax newsletters;
- Two tickets to the event (value = $200);
- Exhibit space for the event exclusively to the co-sponsors (value = $500); &
- Printed recognition on all INCMA materials for the event and at the event.

Please send an invoice. *

Yes No

Checks may be mailed to:
INCMA
PO Box 441743
Indianapolis, IN 46244

2012 INCMA Legislative Conference Registration Form$120 per attendee

2012 INCMA Legislative Conference Registration Form
$120 per attendee