2014 Impact80 Caregiving & Health Summit 2014 Fall Impact80 Virtual Summit Sponsorship - Page 13

--- Sponsorship & advertising Commitment Form ---

2014 IMPACT80 Summit --- Nov 18th, 2014

Yes, I want to commit to support the 2014 IMPACT80 Summit as noted below. I understand that my signature signifies my commitment to pay for all sponsorship and/or advertising opportunities as stipulated herein.

Name: _____________________________

Company: __________________________

Signature:__________________________

Date: _____________________________

Total Commitment $: ________________

To complete sponsorship send your total commitment and email this form signed to info@carenovate.com

SPONSORSHIP LEVELS

Platinum Sponsor: $2,000

Gold Sponsor: $1,000

Silver Sponsor: $750

Summit Ambassador Sponsor $500

Start Up Sponsor: $250

CLICK on the page,

you will be directed to

payment page

2014 IMPACT80 Summit ---NOV 18th, 2014

info@carenovate.com www.carenovatemag.com