2019 Safety Excellence Awards Banquet Registration

Theme: "Aiming for Safety Excellence"

Guest Speaker: John Jackson from Out da Bayou TV

Thursday, April 4, 2019

5:00 p.m. Cocktail Reception
6:00 p.m. Dinner & Awards Program

L'Auberge Baton Rouge, LA
777 L'Auberge Ave., Baton Rouge, LA 70820

If you are the contact for your company that purchased a 2019 GBRIA Platinum, Gold, Silver or Bronze Sponsorship Package, contact Sue Leger (225-769-0596, Ext 10) or sue@gbria.org for your Pre-Paid Table or Pre-Paid Seats and Event Sponsorship Level Recognition.

You may also register additional Tables or Seats with your Sponsorship Package below.

Please note, if you have Pre-Paid Seats or a Table, you must register to have your Seats/Table reserved!

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* 1. Company Name

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* 2. Company Address

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* 3. Contact Person Registering

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* 4. Contact Phone Number

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* 5. Contact E-Mail Address

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* 6. How many Regular Tables of 10 at $1,161 per table would you like to reserve? (Saves $129)

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* 7. List Both Name and Company of attendees:

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* 8. How many Individual Seats at $129 per seat would you like to reserve?

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* 9. List Both Name and Company of attendees:

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* 10. We would like to be an Awards Event Sponsor!

$1,950 - Platinum Sponsor (Table for 10 + Premium branding throughout event)

$1,595 - Gold Sponsor (Table for 10 + Company logo represented throughout event)

$ 1,025 - Silver Sponsor (5 seats + Company logo in presentation & program)

$500 - Bronze Sponsor (2 seats + Company logo in program)

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* 11. How would you like to pay?

Check (Please Note: Seats and Tables will only be reserved once check is received.)

Invoice Me (Please Note: Seats and Tables will only be reserved once payment is received.)

Credit Card - Survey Monkey will redirect you to credit card payment page when submitted.