11

th
NaFFAA Empowerment Conference
We Break the Dawn: Master Planning the Future
August 7 to August 10, 2014 Town and Country Resort & Convention Center
http://Empowerment.NaFFAA10.org


SOUVENIR PROGRAM ADVERTISER RESPONSE FORM
Response Required & Deadline Submission of Camera-Ready Ads: July 16, 2014

1. Please scan & email the completed & signed Form to Leezel@naffaa10.org and Karl@naffaa10.org together with your camera-
ready ad. All camera-ready ads are emailed to Leezel@naffaa10.org. AND / OR
2. Please mail a copy of the completed & signed form with your check payment to NaFFAA Region 10 c/o Leezel Ramos, 1341 E. 8
th

Street, Suite A, National City, CA 91950 to arrive no later than July 18, 2014.
3. If emailing scanned & signed Form only, send your check payment to arrive no later than July 18, 2014.
4. If emailing scanned & sign Form together with camera-ready ad, you can pay via PayPal. Contact Karl@naffaa10.org for details.
Follow up via SMS to Karl at (419) 410-1095. (Time Zone Central Daylight Savings Time)
5. For Community Partnerships, encircle type of partnership. For Media Partnerships, contact Karl Buno.

To: Chairperson, Souvenir Program
Kindly reserve space in the 11
th
NaFFAA Empowerment Conferences Souvenir Program. Upon the receipt of my payment,
the NEC 2014 Souvenir Program Committee will send a confirming email to me --- which will also serve as my receipt.

SERVICE DESIRED FOR AD:
( ) Full-Page Ad $150 Full Color ( ) Quarter Page (1/4 Page) $40
( ) Half-Page Ad $75 Full Color ( ) Eighth Page $25
( ) Community
Partner
Refer to Sponsorship Response Form: Advocate $20+; Fellow $50+; Collaborator $250+; media
sponsorship

Company/
Organization Name:


Contact Name:


Address:


City, State, Zip:

Phone Number
(Day):
Fax
Number:

E-mail:


PLEASE CHECK ALL THAT APPLY:



My check is enclosed, payable to NaFFAA Region 10. I am
mailing the check, my signed & completed Advertiser Response
Form, & a CD or USB of my camera-ready ad to: Leezel Ramos
at NaFFAA Region 10 | 1341 E. 8th St., Suite A | National City,
CA 91950



I am interested in attending the 11
th
NaFFAA Empowerment
Conference. Please send me more information.



I am emailing my signed & completed Advertiser Response
Form to Leezel@naffaa10.org and Karl@naffaa10.org with my
attached camera-ready ad/artwork in PDF format or JPEG file
(min. of 300 dpi).



I am interested in attending the Gala Night Event on August 9,
2014. Please send me more information.



I am paying via PayPal. I am emailing Karl Buno for instructions
at karl@naffaa10.org. I can follow up via SMS (419) 410-1095.



I am interested in donating products or services for the special
drawings during the Gala Night. Please send me the details.



Please email me a scanned copy of the tear sheet of my ad to
my email address, which is _________________________.



Comments: __________________________________________.

NAME (Please print):

SIGNATURE: DATE: