2017 Fall ICIMA Sponsor Registration Form
Event Timing: October 5 & 6, 2017

Event Location: Starved Rock Lodge & Conference Center
Event Address: 2668 E. 875th Road. Oglesby, IL 61348

Contact us at 630-444-3080 or laskycharles@co.kane.il.us

Cost: $600 per vendor plus $50 per person for dinner (one dinner included with sponsorship)

Sponsorship provides vendors a great opportunity to connect during the evening hours and over dinner with key players from county IT departments from throughout the state of Illinois.

Email address *
What is ICIMA
The Illinois County Information Management Association (ICIMA) is comprised of Information Technology Directors and/or senior staff members from Information Technology Departments (non-elected office holders) for County through out the state of Illinois. The organization was born out of a strong need to provide a forum for the exchange of technical information, skill sets, and ideas. As a professional group, ICIMA strives to increase the level of government technical services that are provided to the citizens of Illinois through enhanced utilization of hardware, software, telephony, security implementations and measures, as well as application development. ICIMA focuses on sharing technical issues that are exclusively related to government information processing and automation.
Sponsor Information
Company Name *
Your answer
Contact Name *
Your answer
Phone Number *
Your answer
Mailing Address *
Your answer
Description of Products and/or Services Offered *
Your answer
Number of people attending Dinner on Oct 5 *
Your answer
Names of people attending Dinner *
Your answer
$600 per vendor plus $50 per person for dinner (one dinner included with sponsorship)
Enter the total amount of your sponsorship: $600 plus $50 per person attending dinner (one dinner is included in sponsorship) *
Your answer
Please complete this form and submit payment for your sponsorship by August 25, 2017 to:

ICIMA c\o Kane County I.T. Department
Attn: Charles Lasky
719 S. Batavia Ave
Geneva, IL 60134

Paying by Check:
The check must be made out to:

Paying by Credit Card:
If you would like to pay by credit card, email laskycharles@co.kane.il.us and he will send you a PayPal request to pay which will allow you to pay by credit card for the amount of your sponsorship. A PayPal account is not required for credit card payments.

Would you like a payment request sent to your email so you can pay by credit card? *
Other Comments or Questions
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