Online Souvenir Program Sponsorship Form

2nd-biennial-cover Thank you for your interest in our souvenir program. If you would like to sponsor an ad or greeting in our Second BM&R Souvenir Program, please follow these steps:

Fill up the form below.
Pay either by credit/debit card or by check.
Send your camera-ready Ad or Greetings to Dr. Marlon Torrento via mtorrentomd@gmail.com.

Souvenir Program Sponsorship Form

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Your message has been sent

Name (Last, First, MI)

Street Address

City

State/Province

Zip Code

Country

Email (Your receipt will be emailed to you.)

Level of Sponsorship

By checking this box, I certify that the above information is correct and represents my pledge of support for the publication of the USAPMTIAA’s Second Biennial Meeting & Reunion souvenir program.

Mode of Payment

Paying by Credit Card

If paying by credit card, please follow the link to PayPal.

Paying by Check

If paying by check, please write a check in the amount of indicated above payable to USAPMTIAA. Please mail the check to:

Ednie A Mckeehan
USAPMTIAA Treasurer
PO Box 270240
St. Louis, MO 63127
USA

Incentives for Sponsor

Souvenir Ad Incentives

Thank you for your interest in supporting our Second Biennial Meeting & Reunion souvenir program.

USAPMTIAA is a 501(c)3 organization. The donation you send to USAPMTIAA is tax-deductible. Please consult your accountant.