Silver Syringe Sponsorship Form

Silver Syringe Sponsorship Form

If you are interested in sponsoring the 2013 Silver Syringe Awards, please complete the following form.

PLEASE NOTE: All sponsorships must be submitted by Friday, January 18, 2013 in order to be included in all marketing outreach. For questions or problems, please contact Immunize Nevada at 775-870-4338 or e-mail

The 2013 Silver Syringe Awards are set for Thursday, March 14 at the Grand Sierra Resort in Reno, Nev. The VIP reception begins at 5:30 p.m. followed by the dinner program at 6:30 p.m.

Name or Company Name *

Contact Name *

Mailing Address *

Phone Number *

Fax Number

E-mail Address *

Company Website URL

Level of Sponsorship *

50 cc - $5,000 (two complimentary tables of 8)

20 cc - $2,000 (one complimentary table of 8)

10 cc - $1,000 (four complimentary seats)

5 cc - $500 (two complimentary seats)

Depending on your sponsorship level, please provide the first and last name of your guests. *

Total Payment * $

Paid By *

Payment Type *

Check will be mailed to 5250 Neil Rd. Ste. 103 - Reno, NV 89502

Pay by Credit Card (please call 775-870-4338 to provide credit card infomation)