Building Bridges Conference Sponsorship

First Name * Field is required.

Last Name * Field is required.

Company/Organization Name

Address (Line 1) * Field is required.

Address (Line 2)

City * Field is required.

Province * Field is required.

Postal Code * Field is required.

Telephone (Work)

Telephone (Cell)

E-mail * Field is required.

Sponsorship Level

Platinum ($5,000+)

Gold ($2,500-$4,999)

Silver ($1,000-$2,499)

Bronze ($500-$999)

Building Bridges Sponsor ($499 and below)

Sponsorship Amount * Field is required. $

Payment Method

Please indicate how you wish to make your payment for the sponsorship.

I will mail a cheque or money order

I would like to pay using my credit card, over the phone

I would like to pay online using my credit card

I would like to pay online using my PayPal account

I would like to make some other arrangement for payment

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