Name of Sponsor*:
Contact Person* (representative coordinating with BC Kidney Days team):
Mailing Address* (Billing address to send invoice for payment to):
City*: Province/State: Outside U.S./Canada AB Alberta BC British Columbia MB Manitoba NB New Brunswick NL Newfoundland/Labrador NS Nova Scotia NT Northwest Territories NU Nunavut ON Ontario PE Prince Edward Island QC Quebec SK Saskatchewan YT Yukon AK Alaska AL Alabama AR Arkansas AS American Samoa AZ Arizona CA California CO Colorado CT Connecticut DC District of Columbia DE Delaware FL Florida FM Micronesia GA Georgia GU Guam HI Hawaii IA Iowa ID Idaho IL Illinois IN Indiana KS Kansas KY Kentucky LA Louisiana MA Massachusetts MD Maryland ME Maine MI Michigan MN Minnesota MO Missouri MP Northern Marianas MS Mississippi MT Montana NC North Carolina ND North Dakota NE Nebraska NH New Hampshire NJ New Jersey NM New Mexico NV Nevada NY New York OH Ohio OK Oklahoma OR Oregon PA Pennsylvania PR Puerto Rico RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VA Virginia VI Virgin Islands VT Vermont WA Washington WI Wisconsin WV West Virginia WY Wyoming Country:* CanadaUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia HercegovinaBotswanaBouvet IslandBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, DPRKKorea, Republic ofKuwaitKyrgyzstanLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldova, Republic ofMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSvalbard/Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaViet NamVirgin Islands (British)Virgin Islands (US)Wallis and Futuna IslandsWestern SaharaYemen, Republic ofYugoslaviaZambiaZimbabwe
Postal Code/ZIP*:
Contact Number* (for above person):
Email* (for above person):
Company Name (exactly as you would like it appear in the conference marketing materials): *
Photo upload (JPG or EPS, max 2MB)
Representatives attending: As a x level sponsor, you are entitled to complimentary registration for x representative. If you do not currently have this information, please leave blank and email the name of your representative, no later than June 20, to sallan2@bcrenal.ca
As a x level sponsor, you are entitled to the following benefits: