Journal/Program

Program Advertising Contract 

All materials must be received by November 1, 2019. Business cards are acceptable. If not providing materials, please attach copy.

Name/Company  _____________________________________________

Address  ___________________________________________________

City/State/Zip ________________________   Telephone __________________    

Email _______________________

I cannot attend, enclosed is my contribution for _______________________________

Visa/MC Account Number___________________________________ 

Expiration Date ___________

Amount to be billed to card _____________  

Type of ticket(s) ________________   

Number of Tickets __________

Signature _____________________________________________

Please make your check payable to The Jane Elissa Endowment Fund and mail to:

Jane Elissa Meyers
500 West 43rd Street, Suite 10F
New York, NY 10036
917-325-1085