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Easterseals Southeastern Pennsylvania Spring Carnival Sponsorship
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Please indicate which level of tax deductible sponsorship you are interested in:
$50.00
- Gem
$75.00
- Brass
$100.00
- Copper
$250.00
- Bronze
$500.00
- Silver
$1,000.00
- Gold
$1,500.00
- Diamond
$2,500.00
- Platinum
$5,000.00
- Ultimate
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Billing Information
Company Name
Title:
Mr.
Ms.
Mrs.
Miss
Dr.
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First Name:
Last Name:
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Street 1:
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State/Province:
AK - Alaska
AL - Alabama
AR - Arkansas
AZ - Arizona
CA - California
CO - Colorado
CT - Connecticut
DC - District of Columbia
DE - Delaware
FL - Florida
GA - Georgia
HI - Hawaii
IA - Iowa
ID - Idaho
IL - Illinois
IN - Indiana
KS - Kansas
KY - Kentucky
LA - Louisiana
MA - Massachusetts
MD - Maryland
ME - Maine
MI - Michigan
MN - Minnesota
MO - Missouri
MS - Mississippi
MT - Montana
NC - North Carolina
ND - North Dakota
NE - Nebraska
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VA - Virginia
VT - Vermont
WA - Washington
WI - Wisconsin
WV - West Virginia
WY - Wyoming
AS - American Samoa
FM - Federated States of Micronesia
GU - Guam
MH - Marshall Islands
MP - Northern Mariana Islands
PR - Puerto Rico
PW - Palau
VI - Virgin Islands
AA - Armed Forces Americas
AE - Armed Forces
AP - Armed Forces Pacific
AB - Alberta
BC - British Columbia
MB - Manitoba
NB - New Brunswick
NL - Newfoundland and Labrador
NS - Nova Scotia
NT - Northwest Territories
NU - Nunavut
ON - Ontario
PE - Prince Edward Island
QC - Quebec
SK - Saskatchewan
YT - Yukon
None
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ZIP/Postal Code:
Phone Number:
Email Address:
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Payment Information
Payment Method:
Credit Card
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Credit Card Information:
Credit Card Type:
Credit Card Number:
Expiration Date:
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2024
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2030
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2034
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