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2026 Champions of Safety Sponsorship Program
Fill out the form below to complete your sponsorship request
Location
IISC
1501 42nd St STE 100
West Des Moines
, IA
50266
Person(s) to Register
Promo Code
1. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
2. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
3. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
4. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
5. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
6. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
7. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
8. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
9. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
10. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
11. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
12. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
13. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
14. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
15. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
16. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
17. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
18. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
19. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
20. Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
1. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
2. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
3. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
4. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
5. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
6. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
7. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
8. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
9. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
10. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
11. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
12. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
13. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
14. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
15. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
16. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
17. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
18. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
19. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
20. Non-Member Registration Information
Company Name
Name *
Primary Email Address
Phone Number
Billing Info:
Company Name *
First Name *
Last Name *
Company Address *
Company City *
Company State *
-
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Company Zip *
Phone *
Primary Billing Email *
Member ID
Send Invoice
Yes
(To pay with a credit card, leave this box unchecked and enter card information on the next page.)
Company Name (as you would like it listed in sponsorship materials) *
Contact Name (if different from billing info)
Contact Email (if different from billing info)
Sponsorship Level
Friend of Safety - $50
Partner in Safety - $150
Mentor in Safety - $500
Leader in Safety - $1500
Trailblazer in Safety - $2500
Visionary in Safety - $5000
Legacy Builder - $10000
N/A
PDC Exclusive Sponsorships
Wednesday Opening Session Keynote - $10000
Thursday Awards Ceremony Keynote - $10000
Additional Sponsorships
Training Room Sponsor - $20000
New Training Room Tables - $7500
New Training Room Chairs - $6500