To RSVP or for more information, contact us at
631-261-0242 or info@visionlongisland.org
[ ] Leader ($15,000) [ ] Leader ($10,000) [ ] Gold Sponsor ($5,000) [ ] Sponsor ($2,000) [ ] ___ seats ($125)
Ad size: [ ] Full page color (8” x 10.5”) ($1,000) [ ] Half page color (8” x 5.25”) ($500)
Method of Payment: [ ] Check enclosed [ ] Check sent (faxed replies only) [ ] Pay at the door [ ] Credit Card
Attendee Name(s): ____________________________________________________________________________________________
Affiliation:_____________________________________________________________________________________________________
Address: ____________________________________________________City, State, Zip: ___________________________________
Email: _______________________________________ Phone: ____________________________ Fax: ________________________
Credit Card: [ ] Visa [ ] MasterCard [ ] American Express Name, as it appears on card: ____________________________________
Credit Card Number: __________________________________________________ Expiration Date: ___________________________ |