Organization Sponsor Form

Organization Name *

Full Name of Representative *

First

Last

Title of Representative *

Email *

Phone Number *

Mailing Address *

City *

Zip Code *

Yes, we will be an organization sponsor at the following level

• $10,000 Visionary
• $5,000 Champion
• $2,500 Embassy
• $1,000 Global
• $500 Passport

Electronic Signature *

The undersigned hereby affirms that, “I am duly authorized to enter this contract and personally and individually guarantee the terms specified herein.”

Date *

Submit

Please make check payable to “International Center of the Capital Region” and mail to: 80 Vandenburgh Ave. Troy, NY 12180, and and send your high resolution logo to: [email protected]. If you prefer to pay with credit card, please call us at: 518-708-7608 or pay online.