Automate LIVE Sponsorship Order Form

Please complete the form below.

*

First name
*

Last name
*

Job title
*

Email address
*

Company name
*

Automate Booth Number
*

Desired sponsorship type

 Automate LIVE Package - $2,500.00
Add-on Option to Create and Share a 30 Second Video Ad - $1,000.00
Automate In-Booth Video Package - $2,500.00

Please select your 3 preferred time slots for your interview(s).

 Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM

Of the 3 timeslots selected above, please list order of preference
words left

If known, please share the following information

Name of interviewee(s)

Job title of interviewee(s)

Company of interviewee(s)

Topic/title of interview

Please include any comments you would like us to be aware of. If you have a preferred interview host you would like to work with, please enter their name here.
words left

Thank you for your support of Automate Live! An A3 team member will be in touch with next steps and more details. If you have any questions, please email A3 VP of Membership and Business Intelligence, Alex Shikany.


Bill Me Later:
Billing Information (* All fields are required)
Please check here if same as above.
First Name:
Last Name:
Business Title:
Company:
Address:
 
City:
State/Province:
Zip/Postal Code:
Country:
Email Address:
Telephone:
Credit Card Information
Credit Card Type:
Credit Card Number: (do not enter dashes or spaces)
Credit Card CSC: (3 or 4 digit number on the back of your card)
Expires: /
Name: (as it appears on card)
Total Amount:

Clicking submit will charge your credit card with the total amount listed above.

Leave this field empty