2018 Walk to End Alzheimer's Exhibitor Form Alzheimer's ...
2018 Walk to End Alzheimer's Exhibitor Form Alzheimer's Association California Southland Chapter
EXHIBITOR OPTIONS: ___ 1 Walks ($400) ___ 2 Walks ($600) ___ 3 Walks ($800) ___ 4 Walks ($1000) ___ 5 Walks ($1200) ___ 6 Walks ($1400)
___ 7 Walks ($1500) ___ 8 Walks ($1600) ___ 9 Walks ($1700) ___ 10 Walks ($1800) ___ 11 Walks ($1900)
PLEASE SELECT WALK(S):
Ontario | 09.16 | Ontario Mills
Riverside | 09.22 | Martha McLean Anza Narrows Park
Santa Monica/Westside | 09.23 | Tongva Park
| 09. | Hermosa Beach Pier
San Fernando Valley | 0 . |
Santa Clarita | 10.0 | Bridgeport Park
| 10. |
| 10. |
| 10. |
|
Company: _______________________________________ Contact Person: _____________________________________
Address: _________________________________________ City, State, Zip: _______________________________________
Phone: ___________________________________________ Fax: _______________________________________________
Email: ________________________________________________________________________________________________
Company Website: _______________________________________________________________________________________
PAYMENT: $ _______________________
Enclosed is my check made payable to: Alzheimer's Association.
Please invoice me. I understand that payment is required prior to the event.
Please charge my credit card:
Visa
Mastercard
AMEX
Name on Card: ____________________________________________________ Exp Date: ____________________________
Card #: __________________________________________________________ Security Code: ________________________
Signature: ______________________________________________________________________________________________
Billing address: _________________________________________ City, State, Zip: ___________________________________
SEND EXHIBITOR FORM AND LOGO TO:
Yolanda Van Dyke 626.756.5041 cell 844.458.8009 fax yvandyke@
Alzheimer's Association 9606 S. Santa Monica Blvd.
Suite 200 Beverly Hills, CA 90210
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