PawsAbilities 2012 Sponsors

Sponsor Registration Form

Please submit this form no later than March 1, 2012

Deadline for t-shirt logos: February 1, 2012
Deadline for ad copy and logos: February 10, 2012

Please email your logos for PawsAbilities t-shirts to Vikki Lagaza (vlagaza @ keystonehumanservices.org) by February 1, 2012.

Email your camera-ready ad and logo copy to Vikki Lagaza (vlagaza @ keystonehumanservices.org) by February 10, 2012.

Payment can be made by check, payable to “PawsAbilities 2012”; or credit card (American Express, VISA, MasterCard and Discover).

---

(* denotes required information)

Company *
Contact Name *
Address *
City *
State *	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP *
Phone *
Fax
E-mail *
Website
PA Sales Tax ID Number
Product Line *
Electricity	Yes No
Sponsor Level *	Diamond $10,000 Sponsor Gold $5,000 Sponsor Silver $2,500 Sponsor Bronze $1,000 Sponsor $500 Sponsor $250 Sponsor $150 Sponsor $75 Sponsor $40 Sponsor $25 Sponsor
Booth Size	10' x 10' 20' x 10' (Booths available to Diamond, Gold and Silver Sponsors)
Total Payment *	$ Example: 5000.00
Method of Payment *	Check

• 
•