sponsorship form

YES, our organization will participate! We will: (select all that apply)

1. Premier (Exclusive) Sponsor | $5,000
_____ $5,000 Cash
_____ Combination of $_____ Cash and $_____ Inkind, total $5,000; (detail contribution)

             _______________________________________________________________

2. Major Sponsor | $3,000
_____ $3,000 Cash
_____ $3,000 Inkind; (detail contribution)
_____ Combination of $_____ Cash and $_____ Inkind, total $3,000; (detail contribution)

             _______________________________________________________________

3. Supporting Sponsor | $1,000
_____ $1,000 Cash
_____ $1,000 Inkind; (detail contribution)
_____ Combination of $_____ Cash and $_____ Inkind, total $1,000; (detail contribution)

             _______________________________________________________________

4. Table Sponsor | $500
_____ $500 Cash
_____ $500 Inkind; (detail contribution)
_____ Combination of $_____ Cash and $_____ Inkind, total $500; (detail contribution)

Total Sponsorship: $____________________

Authorized Signature: _______________________________________________

Organization Name: __________________________________________________

Address: ___________________________________________________________

Payment Date: ______________________________________________________

Billing Information: ___________________________________________________

Contact Person for Sponsorship: ________________________________________

Phone: ________________________________     Fax: ______________________

Email: ____________________________________________________________

_____ Payment enclosed     _____ Bill Me (due March 1, 2012)

Mail or fax completed form to:

Post Office Box 68
Albany, Oregon 97321
fax (541) 926-1378

In order to be listed in all pre-event publicity,
response must be received no later than February 29, 2012.