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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 dreno@swhd.org
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
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