| Donor/Advertiser Information | |||
| Title | State | ||
| First Name | Zip | ||
| Last Name | Country | ||
| Address | Phone | ||
| City | |||
| Ad Journal sizes | Insert your AD below
or Email as a Attachment |
||||
| $50 | 1/8 page ad (2 Line Greeting) | ||||
| $100 | 1/4 page ad (Business Card) | ||||
| $180 | 1/2 page ad | ||||
| $500 | Bronze Page + 2 Dinner reservations | ||||
| $1,000 | Silver Page + 3 Dinner reservations | ||||
| $1,800 | Gold Page + 4 Dinner reserevations | ||||
| $3,600 | Platinum Page + 5 Dinner reservations | ||||
| Dinner Reservation: | |
| Number of guest attending | |
| I'm unable to attend | Pleas accept my donation in the amount of Other |
| Payment Information: | |
| Card Type | |
| Card Number | |
| Expiration Date | |
| CVV Security Code | |
| Amount to be charged | |
