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 email@example.com. ____ I give POB permission to design an advertisement for my company.