Purchasing a a partnership opportunity is a two-step process.  First, complete the form on this page to add your information to the conference database.  You will then be directed to the next page in which you can add your purchases to the PayPal shopping cart, or exit if providing an in-kind item or paying for a partnership opportunity with check.

(*) Required Fields

Company Information:

Company Name*:  

Contact Name*:              

Address*:              

City*:     State*: NE AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MO MT NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY              Zip*:              

Phone*:                   Email Address of Contact Person*:                

Company Website Address:              

Please indicate how payment will be made for a partnership opportunity: -- Select One -- Credit Card Check

Partnership Opportunities:

To partner with the 2009 Heartland Conference of Mediators, select the appropriate level: -- Select One -- Gold - $1,000 Silver - $500 Bronze - $250 Honorary - $100 NA - Providing an in-kind item only

For the gold and silver level, please indicate the name of the person who will be using the registration discount: 

Exclusive Partnership Items:

These exclusive partnerships items receive recognition for each special item and will be listed on the conference materials and promotions.  Items may be printed with your company logo and/or the conference logo. 

To provide/purchase an exclusive partnership item, select the appropriate option: -- Select One -- Conference Bags - PROVIDED BY NMCA Notepads (in-kind); qty 150 Pens - PROVIDED BY AMM Volunteer Pullover (in-kind); qty 25

Ready to continue?               -- Select -- Ready