Underwriter and Exhibitor Registration Form PCB Conference September 16-19, 2021 Underwriter and Exhibitor Registration Form Please consider becoming an underwriter for the 2021 PCB Conference. Information is included regarding levels and acknowledgements.If you would like additional information about the opportunities, please visit the 2021 Exhibit Options page. Contact Person*FirstLast Work Phone* Email* Cell Phone* Underwriter LevelsSelect levelCommunity Hero ($2,500)Community Builder ($1,500)Community Organizer ($1,000)Community Advocate ($500)Community Supporter ($250) For Profit Business A La Carte OptionsComplimentary Listing: Company, Phone, Email, Website (FREE)Feature Announcement: 150-word max ($100)Brief Announcement: 75-word max ($70)Nugget Announcement: 35-word max ($40)Prerecorded Exhibit: 30-min. max ($125)Prerecorded Exhibit: 15-min. max ($75)Live Interactive Exhibit: 60-min. slot ($200)Live Interactive Exhibit: 30-min. slot ($160) Nonprofit/Chapter/Peer A La Carte OptionsComplimentary Listing: Company, Phone, Email, Website (FREE)Feature Announcement: 150-word max ($75)Brief Announcement: 75-word max ($52.50)Nugget Announcement: 35-word max ($30)Prerecorded Exhibit: 30-min. max ($93.75)Prerecorded Exhibit: 15-min. max ($56.20)Live Interactive Exhibit: 60-min. slot ($150)Live Interactive Exhibit: 30-min. slot ($120)Complimentary Listing for the Conference Program Company Name Company Phone Company Website Company Email Our company would like to donate a prize to the Live AuctionYesNo Please describePlease commit to underwriting as soon as possible so we can begin acknowledging your support. A conference liaison will soon be in touch to coordinate your underwriting and exhibiting details. Final due date for payment and promotional materials is Friday, August 20, 2021. TotalTo pay online by PayPal or credit card click submit.Note: This will take you in to the PayPal screen. If you don't have PayPal, click “Guest Checkout” to enter your email address and begin the process to pay by credit or debit card. Once you submit your payment information, it will give you an opportunity to sign up for PayPal. You’ll need to click the “Not Now” button to process your payment confirmation.SubmitResetTo pay via check or money order, please click submit and then send payment to: Pennsylvania Council of the Blind, PO Box 68, Volant, PA, 16156. You may also pay by calling our office at 717-920-9999.