Sponsor Form

Thank you for sponsoring this important program!
In an effort to help make sponsorship easy, please complete the appropriate information and payment can be made, if using a credit card, on the final page.  Checks can be sent to: Pulse CPSEA PO Box 353 Wantagh, NY 11793-0353.  Any questions filling out this form, please call (516) 579-4711.
 
E-mail your logo to icorina@pulsecenterforpatientsafety.org. Please put "logo" in the subject for prompt attention.
 
Thank you for your support!
To show our appreciation, all sponsors logo's will be displayed on this website and at the program.

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* 1. Company Name (as it will appear on written material)

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* 2. Name of person completing this form

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* 3. Phone number

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* 4. E-mail

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* 5. Website

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* 6. Type of Sponsorship

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* 7. Circle of Friends

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* 8. Are you willing to be contacted for a press release or quote?

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