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Sponsorship Online Payment Form
*
Quantity
$10,000
-
Presenting Sponsor
0
1
1
$5,000
-
Premier Sponsor
0
1
1
$2,500
-
Promotor Sponsor
0
1
1
$1,000
-
Advocate Sponsor
0
1
1
$500
-
Supporter Sponsor
0
1
1
$250
-
Friend Sponsor
0
1
1
Name (Person Completing Form)
*
First Name
Last Name
Organization Name
Email
Verify Email
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Add 3% to my total amount to help cover the payment processing fees