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3rd Annual
Fall Mine Mixer Conference
October 13th, 2011
Phoenix Airport Marriott
Phoenix, Arizona

SPONSORSHIIP FORM: (Please complete a registration form for each attendee) Sponsorships are available at the following levels: Gold $1,000 -includes registration for 8, will be listed in conference guide and signage with company logo Silver 500 - includes registration for 4 persons, will be listed in conference guide and signage with company logo Bronze $250 - includes registration for 2 persons and listed in conference guide and signage with company logo Claim Stake $150+ includes registration for 1 person and listed in conference guide. Other sponsorships include: Breakfast, Lunch and Special Guest Speaker. For more information contact Laurie Swartzbaugh, Deputy Director at 602‐542‐5971 If you prefer to download the form and fax it to us, please use this link.
Your Name
Email Address
Organization Name
Phone Number
Street Address
City
State
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Sponsorship Type
Special Instructions for Sponsorship:
Conference Location: Phoenix Airport Marriott 1101 N 44th Street Phoenix, AZ 85008 602‐273‐7373	Enter Security Code:

Make checks or money orders payable to: Arizona State Mine Inspector 1700 W Washington Phoenix, Arizona 85007