Sponsor's Contract

Company ____________________________________________________

Contact Name: ________________________________________________

Address: _____________________________________________________

City:  ____________________ State:  ________________ Zip: __________

Phone:  _________________________ Fax: ________________________

Email Address:  _______________________________________________

I want to sponsor for

• Diamond  __________________
• Gold         __________________
• Platinum   __________________

[ ] Please check if you want to attend the Forum of which you network with other business professionals.

Please note that this serves as a contract with your signature affixed.

To use VISA or Master Card or Amex for Deposit, and Balance, please fill out below:

Visa:  ________________________   Good Thru:  _____________________
Master Card:  __________________   Good Thru:  _____________________
Amex:  _______________________   Good Thru:  _____________________

Name on card [please print] _______________________________________

Signature:  __________________________ 4-digit card ID#: _____________

The Sponsor agrees to the Rules and Regulation on this event.
Thank you for your kind participation.  Your support is most appreciated.

________________________________          _________________________
            Sponsor’s Signature                                                           Date