Sponsorship Form
Community Outreach Program - Arab Health Education

 How to use this Form:
Use one Form per sponsor
Type in the Form, on screen response, (complete applicable blanks). 
Press "TAB" to move between blank spaces. 
DO NOT CLICK ON "ENTER" while completing the form. If you do that, you will close the form and send incomplete Form!
DO NOT press the  "BACK" button because all information will be deleted if you leave this web page.

.I would like to sponsor the program "Community Outreach Program - Arab Health Education":  Please click on the button for the sponsorship of your choice
      Important Note: Your early payment guarantee your placement at top of your selected category, first come first serve basis.
 
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.  

          

What is Cancer? Cancer warning signals  Breast self-examination Breast Cancer Survivors Doctors' Recommendations
Alzheimers Disease Osteoporosis - Part 1 Osteoporosis - Part 2 Back Pain and Neck Pain Arab Pain Rehab Bulletin Board

.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)  


Name And Contact Information:
First Name
Middle Name
Last Name
Title
Business Name
Number  Street  Suite #
City
State/ Country/ Zip Code
Area Code
Telephone Number
FAX Number 
E-mail Address
Web Site Address 
Sending Your  Sponsorship Form

Payment by Check (USA Sponsors)

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
 

. Payment On line (None USA Sponsors)
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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