2020 – 2021 NATIONAL SPONSORSHIP AGREEMENT
Please complete the following and return it with your check or credit card information. Thank you for your support!
Organization Name: _____________________________________________________________
Contact First & Last Name: ________________________________________________________
Contact’s Title:__________________________________________________________________
Surface Mailing Address: _________________________________________________________ City:__________________________________ State: ________ Zip Code:__________________ Email Address:_________________________________________________________________ Telephone : (_____)_______________________ Fax : ( ____)________________________
Please indicate your sponsorship level:
[ ] Premier $25,000+ [ ] Platinum $5,000+
[ ] Crown $10,000+ [ ] Gold $2,500+
[ ] Silver $1,000+
Method of payment: [ ] Check (payable to HazingPrevention.Org) [ ] Credit card (please specify)
[ ] Visa [ ] MasterCard [ ] Discover [ ] American Express
Name on account:
__________________________________________________________________________________
Account number:
__________________________________________________________________________________
Expiration: CVC Code:
__________________________________________________________________________________
Please mail form and payment to:
HazingPrevention.Org
136 Everett Road
Albany, NY 12205
If you have questions email info@hazingprevention.org