WASHINGTON STATE DERMATOLOGY ASSOCIATION
74ND
Pacific Northwest Dermatological Scientific Meeting
JULY
12-15, 2007
The Coeur d'Alene Golf and Spa resort
Coeur d'Alene, I daho
ADDITIONAL SPONSORSHIP
and/or
EDUCATIONAL GRANT
COMPANY:_________________________________________________________________
CONTACT
NAME:___________________________________________________________
ADDRESS:__________________________________________________________________
CITY:___________________________________STATE:____________ZIP:______________
TELEPHONE: ( )___________________FAX: (
)_________________________
EMAIL:_____________________________________________________________________
We want to SPONSOR one or more
of the following:
£
Scientific Symposium
£
Guest Speaker Expenses & Honoraria
£
Thursday Evening Welcome Reception
£
Coffee Breaks (3 available)
£
Friday
£
Saturday
£
Sunday
£
Continental Breakfast - Friday
£
Continental Breakfast - Saturday
£
Box Lunch – Friday
£
Box Lunch - Saturday
£
Friday Evening Banquet
£
Syllabus Printing Cost
PLATINUM
r
$10,000
r
$12,000
GOLD
r
$7,000
r
$8,000
r
$9,000
SILVER
r $4,000
r $5,000
r $6,000
BRONZE
r $2,000
r $2,500
r $3,000
OTHER:
r
$
CHECK PAYABLE & RETURN THIS FORM TO:
Washington State
Dermatology Association
2033 Sixth Avenue, Suite
1100
Seattle WA 98121
TAX ID # 94-3167911
If you have any questions, please call Kory Diemert at (206) 956-3646.
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