Clone of OrangeCon Trophy Sponsorship Form

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- Month - Day Year

at

: Hour Minutes AM/PM Option

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Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail

Phone Number

- Area Code Phone Number

The cost per Trophy Package is $40.00

Number of Trophy packages you wish to sponsor?

One Two Three Four Five

Please provide the "Sponsored By NAME" as it should appear on the Trophy:

Do you wish to have your sponsorship(s) assigned to where needed:

yes

What categories would you like to sponsor? Please provide a First, second and third preference for your sponsorhip(s). Also, please understand that if all your preferences are already taken, we will assign your sponsorship(s) were needed. Be sure to consult the Category availability listing.

Are you an IPMSOC Member and would like MOTY points:

Yes

Order through Pay Pal

Trophy Sponsorship $ 40.00

Number of Trophy Sponsorships

Total $ 0.00