HMS 87th Annual Scholarship GALA

Tickets

Journal Ads

Journal Ad Form

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REGISTRANT CONFIRMATION ID

CHOOSE A JOURNAL ADVERTISEMENT(Required)

Diamond - $5,000 - On-site Virtual Full Page Journal Ad & 60" Video in Online E-Journal

Platinum - $3,000 - On-site Virtual Full Page Journal Ad & 30" Video in Online E-Journal

Gold - $2,000 - On-site Virtual Journal Ad & Full Page in Online E-Journal

Silver - $1,000 - On-site Virtual Journal Ad & Half Page in Online E-Journal

Bronze - $500 - On-site Virtual Journal Ad & 1/4 Page in Online E-Journal

REGISTRANT NAME(Required)

First Middle Last

EMAIL(Required)

PHONE NUMBER(Required)

ADDRESS(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

YOUR MESSAGE/WISHES FOR THE JOURNAL AD(Required)

UPLOAD YOUR JOURNAL AD IMAGE OR LOGO

If you have an image or logo to include in your ad please upload the file. Please make sure to upload a high resolution image.

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 128 MB.

Would you like to cover the credit card fees as part of your donation?

Yes

PayPal Credit Card fees are 3.5%

REGISTRATION DISCOUNT CODE

Subtotal

$0.00

Credit Card Fees

$0.00

TOTAL AMOUNT DUE NOW

PAYMENT METHOD(Required)

Credit / Debit Card

► *Cancellation Notice: All sales are final. We provide no refunds.

Name

This field is for validation purposes and should be left unchanged.

Sponsorships

Sponsorship Form

REGISTRANT CONFIRMATION ID

CHOOSE A SPONSORSHIP(Required)

Asklepios Benefactor Table - $20,000 - 12 Tickets - Premium Seating, Contribution to Support FOUR (4) HMS Scholarships & Diamond Virtual Ad Package

Platinum Benefactor Table - $10,000 - 12 Tickets - Premium Seating, Contribution to Support One (1) HMS Scholarships & Platinum Virtual Ad Package

Gold Benefactor Table - $6,000 - 10 Tickets & Gold Virtual Package

Silver Benefactor Table - $5,000 - 10 Tickets & Silver Virtual Package

REGISTRANT NAME(Required)

First Middle Last

EMAIL(Required)

PHONE NUMBER(Required)

ADDRESS(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

YOUR MESSAGE/WISHES FOR THE JOURNAL AD(Required)

UPLOAD YOUR JOURNAL AD IMAGE OR LOGO

Please make sure to upload a high resolution image.

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 128 MB.

Would you like to cover the credit card fees as part of your donation?

Yes

PayPal Credit Card fees are 3.5%

REGISTRATION DISCOUNT CODE

Subtotal

$0.00

Credit Card Fees

$0.00

TOTAL AMOUNT DUE NOW

PAYMENT METHOD(Required)

Credit / Debit Card

► *Cancellation Notice: All sales are final. We provide no refunds.

Phone

This field is for validation purposes and should be left unchanged.

Journal Ad Form

Sponsorship Form

Uniting Physicians & Health Care Professionals Of Hellenic Descent

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