2025 SPONSORSHIP FORM

Annual SCJMHS Conference

43nd Annual South Central Joint Mine Health & Safety Conference

April 7-9, 2025 ~CHOCTAW CONFERENCE CENTER~ Durant, OK

Company Name:*
Company Address*
Street Address Address Line 2 City State ZIP Code
Primary Person (Point of Contact):*
First Last
Email*
Phone*
Company Description and Services*
Please provide a brief description of services and / or products the company offers as soon as possible to post to our “2025 LIST OF SPONSORS" webpage-
NOTE: The SCJMHSC Association is legally established under the laws of Texas as a non-profit organization, donations to help fund it are tax-exempt under IRS Code Section 501(c)(3). Each sponsoring organization or individual will receive a copy (if requested) of the Conference Association’s IRS Form W-9 for tax reporting (charitable donation deduction) purposes.
Sponsorship Levels are as follows:*
Please select level for participant registration information:
$5000 Black Diamond Level (Includes 5 paid participant registrations and company bio displayed on our website)
$4000 Diamond Level (Includes 4 paid participant registrations and company bio displayed on our website)
$3000 Platinum Plus Level (Includes 3 paid participant registrations and company bio displayed on our website)
$2000 Platinum Level (Includes 2 paid participant registrations and company bio displayed on our website)
$1000 Gold Level (Includes 1 paid participant registration, and company bio displayed on our website) DEADLINE TO REGISTER AND TO BE ADDED TO THE PROGRAM IS MARCH 1, 2025.
Participant #1
First Last
Participant #2
First Last
Participant #3
First Last
Participant #4
First Last
Participant #5
First Last
IRS Code Section 501(c)(3) Statement
The SCJMHSC Association is legally established under the laws of Texas as a non-profit organization, donations to help fund it are tax-exempt under IRS Code Section 501(c)(3). Each sponsoring organization or individual will receive a copy (if requested) of the Conference Association’s IRS Form W-9 for tax reporting (charitable donation deduction) purposes. DISCLAIMER: By Registering for the conference, you understand photographs will be taken and used on our website. All Company and personal information will be protection. WE DO NOT SHARE ANY LIST OF PARTICIPANTS. Thank you for your support!!
Select Level For Payment*
Please select level that matched your requested level above for payment.
Total
$0.00
Credit Card
Card Billing Information
Phone
This field is for validation purposes and should be left unchanged.

Have questions?

Contact Us

2025 SPONSORSHIP FORM

Annual SCJMHS Conference

IRS Code Section 501(c)(3) Statement

Card Billing Information

Have questions?

Payment Options

Quick Links

Recent Sponsors