How to use this Form:
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Use one Form per sponsor | |
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Type in the Form, on screen response, (complete applicable blanks). | |
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Press "TAB" to move between blank spaces. | |
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DO NOT CLICK ON "ENTER" while completing the form. If you do that, you will close the form and send incomplete Form! | |
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DO NOT press the "BACK" button because all information will be deleted if you leave this web page. |
| Platinum Sponsorship Fee | One Year: $385 | 3 years: $866 | 5 years: $962 |
| Gold Sponsorship Fee | One Year: $275 | 3 years: $618 | 5 years: $687 |
| Silver Sponsorship Fee | One Year: $195 | 3 years: $438 | 5 years: $487 |
Sponsors' Names And Contact Information will be
listed at the following Arabic web sites or they may remain anonymous.
Please select your preference:
Identified
Sponsorship: List my name as described above.
Anonymous
Sponsorship: Do not list my name and my
contact information.
.With
my sponsorship, I would like to receive a
free Arabic web page to describe
our products/services. Samples
.With
my sponsorship, I would like to receive a
free listing at the web site for the
following title which I recommend its development in Arabic language for Arab
health education:
Deadline: November 30, 2010
PAYMENT: Date
payment was sent/mailed
Your check Number
Your Tracking Number
(None USA Sponsors)
| First
Name
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Middle
Name
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Last
Name
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Title
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| Business Name | |
| Number Street Suite # | |
| City | |
| State/ Country/ Zip Code | |
| Area Code | |
| Telephone Number | |
| FAX Number | |
| E-mail Address | |
| Web Site Address |
Please complete, then print the Sponsorship Form and mail it with your check to:
Doctors' Marketing Service
P.O. Box 748 , Lake Forest,
California 92609-0748
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To send your payment online, kindly use the following account information. You may need your bank to help you in the electronic transfer of funds: DOCTORS MARKETING SERVICE Routing Number: 122201198 Account Number: 11072547 Farmers And Merchants Bank To send the completed form on line, click on the button below. >>> Please Review The completed Form before you click on "Send It in". <<< . |
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