Canadian Association for Population Therapeutics Annual Conference

Facts, Figures, and the Art of Health Care Decision-Making:

linking knowledge generation to health outcomes

March 28th – 30th, 2010

The Four Seasons Hotel, Toronto, Ontario

1. Organization Information

Contact Name: Title:

Name of organization:

(please list name as it should appear in printed materials. Do not use capital letters unless your official name is in capital letters)

Mailing Address:

City: Province: Postal Code:

Telephone: Fax: Email:

Contact for future correspondence and confirmation of logistics if different than above:

Name:

Telephone: Fax: Email:

2. Sponsorship:

Platinum: $10,000+ which provides:

· the opportunity to plan a symposium or plenary session

· Program acknowledgement and conference signage as sponsorship of selected symposia or plenary session

· 4 complimentary conference registrations

Gold: $5,000 to $9,999 which provides:

· the opportunity to sponsor a luncheon or delegate reception

· program acknowledgement and conference signage of sponsorship luncheon delegate reception

· 2 complimentary conference registrations

Silver: $2,000 to 4,999 which provides:

· company logo in the conference program and on conference signage

· 1 complimentary conference registration

Bronze: $1,000 to $1,999 which provides:

· company logo in the conference program and on conference signage

3. Authorization

I am the authorized representative of the named organization with full power and authority to sign and deliver this application. The organization agrees to comply with all policies and guidelines contained in the information provided regarding sponsorship and satellite symposia.

Signature of Authorized Officer Date

Method of Payment:

Cheque

Please make cheque payable to Canadian Association for Population Therapeutics.

Invoice

Please invoice my organization as follows:

Additional Information:

For conference signage purposes, all sponsors must provide their company logo in printer ready .eps electronic format by e-mail to .

Complimentary conference registration forms will be provided by Ms. Kris Schindel by e-mail for completion.

Platinum and Gold sponsors will be contacted by the Fundraising Committee Chair, Ms. Angela Rocchi, to discuss their additional opportunities ([E] ; [T] 905.522.2961).