Sponsorship FORM

Choose Sponsorship Level *

Title Sponsor $15,000+

Presenting Sponsor $7,500+

Premier Sponsor $5,000

Platinum Sponsor $3,500

Gold Sponsor $2,500

Silver Sponsor $1,500

Bronze Sponsor $750

Rotary Club & ABA Members $500

Contact *

First Name

Last Name

Company Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

TYPE

VISA

MASTERCARD

AM/EX

ACKNOWLEDGEMENT *

I hereby represent that I have the authority to execute the credit card authorization and agree that this authorization will be effective for the amount (above) and on the date signed (below). I understand and consent to the use of my credit card without my signature on the charge slip, that an email receipt of this payment will serve as confirmation, and this Credit Card Authorization (CCA) cannot be revoked.

TODAY'S DATE *

MM

DD

YYYY