Sponsorship-Exhibitor Request Form - HTA Annual Conference SPONSORSHIP & EXHIBITOR REQUEST FORM Please complete the form below. If you prefer to print and email/mail a copy to HTA, please download the form here: click here. Company * Contact First Name * Contact Last Name * Contact Email * Company Phone Cell Phone SPONSORSHIP SELECTION(S) & PAYMENT DETAILS Click Here to View Benefits at Each Sponsorship Level or Exhibitors Booth Selection Conference Sponsor None SelectedPlatinum $3,750Gold $2,750Silver $1,750Bronze $750 Function Sponsor None SelectedGolf Co-Sponsor $2,250Lunch Co-Sponsor $1,750Entertainment $1,250Break $750 Exhibitors Booth None SelectedHTA Member Booth $1,250Non-Member Booth $1,750 Total How do you plan to pay for the sponsorship or exhibitor booth? Payment via Check (payable to "Hawaii Transportation Association", mailed to: P.O. Box 30166, Honolulu, HI 96820). Payment via Credit Card (2% surcharge will be assessed). Thank you for Registering. Please fill out the form below if you would like to have us charge you via credit card. Name of Cardholder (as it appears on the card): * Email Address for Receipt: * After payment is processed by HTA, a receipt will be emailed to this email address. Billing Address of Cardholder: * Billing City/State/Zip: * Please note the class, event, invoice #, etc. for this payment: * Card type: * Master Card Visa American Express Amount of transaction authorized ($): * Do not include the 2% surcharge, this will be automatically calculated and added by HTA. Credit Card Number: * Expiration (MM/YYYY): * 3 or 4-digit CVC Code: * Phone (XXX-XXX-XXXX) * Signature (By writing out your full name below, you agree to the amount of this transaction and authorize HTA to charge the total to the credit card provided above): * Special Requests Payment notes, food allergies, questions? Submit If you are human, leave this field blank.
