2021 Symposium Sponsorship Application Form
1. PAYMENT METHODS & PROCESS: Ad payment can be made via credit card or check.
Once you have completed this form and clicked the "Submit Now" button, the UAA Executive Office will prepare an electronic invoice. The invoice will be sent to the individual you identify as the invoice recipient.
2. START DATE FOR YOUR AD BENEFITS: Ad benefits do not go into effect until credit card payment is received or your internal institutional check request is documented. So consider paying as soon as possible to maximize the time that you enjoy exposure to members of the UAA online community.
Conference Sponsor Information
Choose 2021 Sponsorship Level
Gold Sponsorship ($500 USD)
Platinum Sponsorship ($1,000 USD)
Diamond Sponsorship ($2,000 USD)
Institution or Organization Name
Official name only. DO NOT USE abbreviations.
Unit Name (If applicable)
(e.g. Academic unit; program or department in an organization)
Address Line 2
State / Province / Region
Postal / Zip Code
Sponsor name as it should appear on UAA's marketing materials/online platforms
Sponsor Name (For marketing listing)
Write the sponsor name EXACTLY as it should appear on UAA's marketing materials/online platforms.
Upload logo that should be used for marketing
IMAGE REQUIREMENT: jpg or .png file and at minimum 1200x1800 pixels (300 dpi)
Please provide the web address that should be linked to your logo
What is your role?
SUBMITTER & PAYER--I am completing this form AND I am the person who should be sent the invoice
SUBMITTER ONLY--I am only completing this form. A different person should be sent the invoice.
Individual Completing this Form
We request this information in the event that we need to contact you regarding this sponsorship application.
Name of Individual Completing this Form
Professional Title of Individual Completing this Form
Email of Individual Completing this Form
Phone of Individual Completing this Form
Invoice Recipient (Not the form submitter)
Invoice Recipient's Name
Invoice Recipient's Professional Title
Invoice Recipient's Email
Confirm Invoice Recipient's Email
Invoice Recipient's Phone
Special Invoice Information (OPTIONAL)
Use this box to let us know what, if any, special information is needed for or should be included on your invoice.
Click the "Submit Now!" button below to complete the application form.