Contact Name *

First Name

Last Name

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Sponsorship Level *

Naming Rights Over $5500

Gold $2200

Silver $1100

Bronze $550

Brass $275

Agreement *

I confirm that I am authorised to commit the named business to the level of sponsorship selected and agree to supply the agreed level of support by financial contribution or goods/services supplied.

Date *

MM

DD

YYYY