Madison Area Conservation Dinner Please complete the following questions for the Table Sponsor ContactSponsoring Union/Company* Contact Name* First Last Select a Union (choose "Friend of Labor" if not a union)*AFA / CWAAFGEAFSCMEAFTAFTRAAGMAALPAATUBACBCTGMBLEBRSCWAFriend of LaborGMPIAFFIAMAWIATSEIBBIBEWIBTICWUCIFPTEILAILWUInsulatorsIronworkersIUAIUE / CWAIUECIUOEIUPAIUPATLIUNAMTTDNACUNALCNATBUNATCANFLPAOPCMIAOPEIUOtherPASSRoofersRWDSUSAG-AFTRASEIUSIUSMARTUAUAWUBCUFCWUMWAUSWUWUALocal # Phone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Product NameChoose Sponsorship Level(s)* Platinum Sponsor ($10,000 & 5 Table Prizes) Gold Sponsor ($5,000 & 3 Table Prizes) Silver Sponsor ($3,000 & 2 Table Prizes) Bronze Sponsor ($1,500 & 1 Table Prize) Veteran Sponsor($2,000 & 1 Table Prize) Platinum Sponsors: Choose a Combination of 5 Table Prizes*Choose a Prize Combo1 Remington / 4 Orca Coolers2 Remingtons / 3 Orca Coolers3 Remingtons / 2 Orca Coolers4 Remingtons / 1 Orca Coolers5 Remingtons5 Orca CoolersGold Sponsors: Choose a Combination of 3 Table Prizes*Choose a Prize Combo2 Remingtons / 1 Orca Cooler1 Remingtons / 2 Orca Coolers3 Remingtons3 Orca CoolersSilver Sponsors: Choose a Combination of 2 Table Prizes*Choose a Prize Combo1 Remington / 1 Orca Cooler2 Remingtons2 Orca CoolersBronze Sponsors: Choose 1 Table Prize*Choose a Prize Combo1 Remington1 Orca CoolerVeteran Sponsors: Choose 1 Table Prize*Choose a Prize Combo1 Remington1 Orca CoolerTotal $0.00 Payment InformationHow would you like to pay?*Choose Payment MethodCredit Card - OnlineCheck - Mail-InPlease mail your check to: Union Sportsmen's Alliance Attn: 9th Annual Madison Area Conservation Dinner 4800 Northfield Lane Spring Hill, TN 37174 Credit Card*Card Details Cardholder Name Billing Address* Same as previous Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code