MCANJ Conference Sponsorship Application

* Fields in red are required

Sponsor Information

Name of Organization or Individual Friend of MCANJ Sponsor:

Contact Person:

Phone:

Email:

Website:

Address:

City:

State:

Zip:

When submitting this form, please email your advertisement to the MCANJ Website Administrator at websitemanager@MCANJ.us

Your ad needs to be submitted in JPG, TIFF or BMP format. If you do not provide an advertisement, we will format one for you, using your Business Name and website address as provided on this registration form. NO ADS WILL BE PLACED UNTIL PAYMENT IS RECEIVED. Registration Closes on March 1, 2024

Payer Information

Billing Name:

Address:

Address 2:

City:

State:

ZIP Code:

Daytime Phone:

Payer E-mail Address:

Payment Information

Payment Amount:

$5000 - PLATINUM SPONSOR

$3000 - DIAMOND SPONSOR

$2000 - GOLD SPONSOR

$1500 - SILVER SPONSOR

$1000 - BRONZE

$500 - CAMP FIRE SPONSOR

$250 - S'MORES SPONSOR

$100 - FRIENDS OF MCANJ

Payment Method:

Credit Card:

Convenience Fee:

Credit Card Number:

Sec. Code:

What is the Security Code?.

What is this and why do I have to do it?
Due to the amount of credit card fraud over the internet, banks will soon REQUIRE this information to process credit card orders online - you can expect to see it used everywhere in the very near future. Your benefit is that it prevents any fraudulent charges using your credit card, i.e. no one can pick up an old receipt of yours and use that info to fraudulently use your credit card. Thanks for your cooperation.

American Express
4 digits on front of card

Visa and Mastercard
last 3 digits on back of card

Note: The digits are printed on your card, rather then stamped in the plastic like the digits in your credit card number.

Exp. (Month/Year):

(2 digits, Range: 24-34)

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