Name:______________________________________________________________________________________

Address:_______________________________________________ E-mail: _____________________________

City:_________________________________ State:_________________ Zip:__________________________

Phone numbers: Day:___________________________ Night:______________________________________

Camp name and number: ___________________________________ Amount $ ________________________ (If applicable)

Is this a donation [ ] or payment for ad space in the 2004 Division Reunion Program * [ ] Please check one or both if applicable*

Please send business card, camera-ready artwork, or we will design an ad for you. Please send text and artwork you want included in the ad if we are to design your ad. Detatch this portion of the brochure and if needed attach an additional sheet of paper. Advertising Rates: Business card ad is $25. 1/4 page is $50, 1/2 page is $100, full page $150. The inside front and back cover are $200 and the back is $250. Ancestor memorials $ 5.00