SPONSOR
Name
First Name
Last Name
Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
ORGANIZATION TO BE SPONSORED
Name of Organization
Organization Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website
Contact at Organization (if known)
Phone Number
-
Area Code
Phone Number
PRODUCT
We would like to sponsor:
A Painted Pedestal PD42A ($700 + $130 shipping)
A Wood Pedestal PW42A ($775 + $130 shipping)
A Desk Top DT10A 9$390 + $50 shipping)
Whatever the Venue/Organization Chooses
Other
Other - Use this Section to Describe Other
Recognition plaque - 2" x 3" to be inlaid on side of donation box (up to 4 lines 20 letters per line)
Submit
Should be Empty: