Pasco Sponsorship Form

Contract
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website *
Company logo*

Browse Files

Cancelof
Representative Contact *

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Which meeting would you like to attend?

Sept 16, 2025Oct 21, 2025Nov 18, 2025Jan 15, 2026Feb 17, 2026April 21, 2026
Payment Type*

CardCheck

Credit Card Payment*

1 Membership Meeting $360.50

3% Credit Card Transaction Fee Applied

2 Meetings $721.00

3% Credit Card Transaction Fee Applied

3 Meetings$1,081.50

3% Credit Card Transaction Fee Applied

4 Meetings $1,442.00

3% Credit Card Transaction Fee Applied

5 Meetings $1,802.50

3% Credit Card Transaction Fee Applied

All Membership Meetings $2,163.00

3% Credit Card Transaction Fee Applied

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Check Amount*
Mail Check Payment:

Pasco County Dental Association

P.O Box 2,

Brandon, FL 33509
Please verify that you are human
For questions, please contact the Pasco Association at wpdasec@gmail.com or call (813) 654-2500.
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Sponsorship Opportunities