Prostate Cancer Awareness Day at the Atlantic Union College sponsor registration form
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- SPONSOR REGISTRATION FORM
- LEVEL OF SPONSORSHIP (See attached details): PLEASE REPLACE WITH THE AUC BROCHURE INFORMATION RE: CORRECT NAME AND $ OF SPONSORSHIP LEVELS
- II. Credit Card
SPONSOR REGISTRATION FORM Please fax this form to AdMeTech Foundation at (617) 507-2439 or email contact@admetechfoundation.org NAME OF COMPANY (IF APPLICABLE): _____________________________________________ REPRESENTATIVE/INDIVIDUAL _____________________________________________ Full Name: ________________________________________ Title: ________________________________________ E-mail: ________________________________________ Phone number: ________________________________________ Address: ________________________________________ LEVEL OF SPONSORSHIP (See attached details): PLEASE REPLACE WITH THE AUC BROCHURE INFORMATION RE: CORRECT NAME AND $ OF SPONSORSHIP LEVELS Silver: $5,000 ___ Bronze: $2,500 ___ Copper: $1,500 ___ Pewter: $500 ___ Exhibitor: $2,500 ___ METHOD OF PAYMENT I. Check ____ Please mail check payable to AdMeTech Foundation to: AdMeTech Foundation, One Boston Place, Suite 2600, Boston, MA 02108 II. Credit Card ____ Name on credit card: ________________ Amount to be charged: $__________ Credit Card Number: ______________________________ Exp. Date: __________ Approval of use via this signature: ___________________________________ III. Wire Transfer or ACH____ Formal Name: Corporation for Advancement of Medical Technologies (DBA AdMeTech Foundation) Routing Number (Bank of America: For Wire___ 026009593 For ACH___ 052001633) Bank account____ 003916329827 Directory: wp-content -> uploads -> 2017 2017 -> Leadership ohio 2017 -> Ascension Lutheran Church Counter’s Schedule January to December 2017 2017 -> Board of directors juanita Gibbons-Delaney, mha, rn president 390 Stone Castle Pass Atlanta, ga 30331 2017 -> Military History Anniversaries 16 thru 31 January Events in History over the next 15 day period that had U. S. military involvement or impacted in some way on U. S military operations or American interests 2017 -> The Or Shalom Cemetery Community Teaching on related issues of Integral 2017 -> Ford onthult samenwerking met Amazon Alexa en introduceert nieuwe navigatiemogelijkheden van Ford sync® 3 met Applink 2017 -> Start Learn and Increase gk. Question (1) Name the term used for talking on internet with the help of text messege? 2017 -> Press release from 24. 03. 2017 From a Charleston Car to a Mafia Sedan 2017 -> Tage Participants 2017 -> Citi Chicago Debate Championship Varsity and jv previews Download 131.14 Kb. Share with your friends:
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