Patron and Advertiser Response Form

Patron Response Form

Please use this form to sign up for an advertisement in our 40th Anniversary Concert program

Company *

Please provide your business name.

Street Address *

City *

State *

Zip Code *

Amount Enclosed *

Contact Name *

First

Last

Contact Phone *

Contact Email

Advertising *

Full Page (4" x 5.5") - $100
Half Page (2" x 3") - $60
Quarter Page (Business Card) - $35
Individual Name Listing - $20

Name to List in Program *

Please provide your company name as you wish to see it listed in our program.

Any Special Requests or Description. Note: This response form along with payment and copy-ready artwork if applicable MUST be received by The Counseling Center office (82 Buck Road, Holland, PA 18966) no later than Saturday, June 1st, 2018. Any questions, please call Linda Manzo at (215) 702-8387

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