MAKERS of Change - Southwest Human Development...MAKERS of Change ASSISTIVE TECHNOLOGY CHALLENGE Sponsorship Commitment Form Sponsor Information Company Name: _____ Contact

MAKERS of Change ASSISTIVE TECHNOLOGY CHALLENGE

Sponsorship Commitment Form

Sponsor Information Company Name: _____________________________________________________________ Contact Person: _____________________________________________________________ Address: ___________________________________________________________________ City: _____________________State: ____________________ZIP Code: _________________ Phone Number: ______________________________________________________________ Email Address: ______________________________________________________________

Sponsorship Commitment Level (Please check one)

$5,000 Gold Sponsor

$2,000 Silver Sponsor

$1,000 Bronze Sponsor

Payment Information

Pay By Enclosed Check Payable to Southwest Human Development

Pay By Credit Card

______________________________________________________________________ Credit Card Number Exp. Date Security Code

______________________________________________________________________ Name As It Appears On Credit Card Cardholder’s Signature

Return this completed form to David Reno at [email protected]

or mail to David Reno, Southwest Human Development, 2850 N. 24th Street, Phoenix, AZ 85008

Print deadline for inclusion on signage and t-shirts is September 14, 2018