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

Name (Last, First, MI)(required)

Street Address(required)

City(required)

State/Province(required)

Zip Code(required)

Country(required)

Email (Your receipt will be emailed to you.)(required)

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.(required)