2023 Inaugural Long Island 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 LaborGMPIAFFIAMAWIATSEBoilermakersIBEWIBTICWUCIFPTEILAILWUInsulatorsIronworkersIUAIUE / CWAIUECIUOEIUPAIUPATLIUNAMTTDNACUNALCNATBUNATCANFLPAOPCMIAOPEIUOtherPASSRoofersRWDSUSAG-AFTRASEIUSIUSMARTSPFPATWUUAUAWUBCUFCWUMWAUSWUWUAOther Union (Submit Your Own)Local #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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin 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 ($3,500 & 2 Table Prizes) Bronze Sponsor ($1,750 & 1 Table Prize) Veteran Sponsor($2,000 & 1 Table Prize) Individual Platinum Sponsors: Choose a Combination of 5 Table Prizes*Choose a Prize Combo1 Savage Axis II / 4 Orca Coolers2 Savage Axis II / 3 Orca Coolers3 Savage Axis II / 2 Orca Coolers4 Savage Axis II / 1 Orca Coolers5 Savage Axis II5 Orca CoolersGold Sponsors: Choose a Combination of 3 Table Prizes*Choose a Prize Combo2 Savage Axis II / 1 Orca Cooler1 Savage Axis II / 2 Orca Coolers3 Savage Axis II3 Orca CoolersSilver Sponsors: Choose a Combination of 2 Table Prizes*Choose a Prize Combo1 Savage Axis II / 1 Orca Cooler2 Savage Axis II2 Orca CoolersBronze Sponsors: Choose 1 Table Prize*Choose a Prize Combo1 Savage Axis II1 Orca CoolerVeteran Sponsors: Choose 1 Table Prize*Choose a Prize Combo1 Savage Axis II1 Orca CoolerTotal $0.00 Payment InformationThis field is hidden when viewing the formHow would you like to pay?*Choose Payment MethodCredit Card - OnlineCheck - Mail-InPlease mail your check to: Union Sportsmen's Alliance Attn: Event Name 4800 Northfield Lane Spring Hill, TN 37174Credit Card*Card Details Cardholder Name Billing Address* Same as previous Street Address Address Line 2 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