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Blue Jean Bash Sponsorship Registration
Name
(Required)
First
Last
Company
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Do you want to pay now or by check later?
(Required)
Yes
No, I'll pay by check
Select Your Sponsorship Level
(Required)
Tier 1 Sponsorship: $3,000
Tier 2 Sponsorship: $1,500
Tier 3 Sponsorship: $750
Feature Prize Sponsor: $500
Raffle Prize Sponsor: $100
Total
Payment Method
PayPal Checkout
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Security Code
Cardholder Name
Select Your Sponsorship Level
(Required)
Tier 1 Sponsorship: $3,000
Tier 2 Sponsorship: $1,500
Tier 3 Sponsorship: $750
Feature Prize Sponsor: $500
Raffle Prize Sponsor: $100