Spotlight Vendor Sponsor – Split 3 Ways "*" indicates required fields The Adult Foster Care Providers of Genesee County would like to thank you for your interest in sponsoring one of our upcoming meetings. Without the support of our Vendor Members, our Non-Profit Association would not be able to provide the services to our members and their residents. Spotlight Vendors are given an opportunity to present their company’s products and or services to the members, prior to our break for lunch. You are welcome to bring any hand outs, samples, etc. If your presentation requires the use of a projector and/or screen, you will need to provide that or let us know in advance. The cost to be a Spotlight Sponsor is $400, which may also be shared with another Vendor Member. This may be paid by check to AFC Provider’s Association, 9412 Miller Road, Swartz Creek MI 48473, or by credit card after filling out this agreement. Please fill out and sign this agreement, complete payment, and we will contact you to reserve a date. Once a date is confirmed, if you are unable to make the scheduled meeting, please notify Rhonda at (810) 348-2040, at least 30 days in advance. Thank you for your support.Business Name* Phone Number*Email Address* Vendor Representative Electronic Signature* Are you currently a member of AFC Providers?* Yes No Spotlight Vendor Sponsors will be added to the directory at no additional charge - we just need some information first!Business Description*Business Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address(If different from business address) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person* First Last Contact Person Phone Number*Contact Person Fax NumberContact Person Email Address* Website Spotlight Vendor Sponsor Total*$133 Payment$134 PaymentCredit CardCard Details Cardholder Name
