Program Advertisement Form

							                          Program Advertisement Form


____________________________________________________________
Name (print clearly for listing purposes)

____________________________________________________________
Business (print clearly for listing purposes)

____________________________________________________________
Business Address, City, State

____________________________________________________________
Business Phone (include area code)

____________________________________________________________
E-mail                                                   Web site (optional)


Yes, I want to promote my business in support of the Prevention of Blindness Society of
Metropolitan Washington’s American Girl Fashion Show.

____ Full-page ($400)

____ Half-page ($250)

____ Quarter-page ($125)


____ My payment in the amount of $_________ is enclosed/will follow (please circle).
Please make check payable to “Prevention of Blindness Society” and send to: American
Girl Fashion Show c/o Prevention of Blindness Society of Metropolitan Washington, 1775
Church Street, NW, Washington, DC 20036.

Charge my Visa ___ MasterCard ___ AMEX ___

________________________________________________________________________
Account Number                          Expiration Date    Verification Code

________________________________________________________________________
Name on Card                            Signature


____ I will submit my own advertisement in high-resolution (300 dpi). Accepted file
formats are PDF, JPG or TIFF. Must be submitted no later than October 19 to
americangirl@youreyes.org.

____ I give POB permission to design an advertisement for my company.