Corporate Sponsorship Program Registration

Employer Name *
Web Site
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contact Name Contact Name * First Last
Contact Email *
Phone Phone * - ### - ### ####
Fax Fax - ### - ### ####
BILLING CONTACT

BILLING CONTACT Billing contact is same as contact listed above. Please submit bill to contact listed below
Billing Contact Name Billing Contact Name First Last
Billing Address (if different than above) Billing Address (if different than above)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Billing Contact Email
Billing Contact Phone (if different than above) Billing Contact Phone (if different than above) - ### - ### ####
Select a Sponsorship Package
Additional Comments
Method of Payment *

Method of Payment Credit Card Please bill to address listed above (I have opted to close the CAshNet payment page after clicking the submit button)
**AFTER CLICKING SUBMIT, you will be directed to the CashNet page regardless of method of payment. If you have opted to receive an invoice or mail a check, simply click out of the CashNet page. Thank you for your support of the career develepment of students at Eastern Illinois University!
*

I have read and understand the above statement