National Multiple Sclerosis Society Hampton Roads Chapter 760 Lynnhaven Parkway, Suite 201 Virginia Beach, VA 23452 Tel + 1 757 490 9627 Fax + 1 757 490 1617 JOIN THE MOVEMENT www.fightMS.com
2011-2012 Advertising/Grant Commitment Form Company Name: _______________________________________________________________________ Contact Person: _______________________________________________________________________ Address: _____________________________________________________________________________ City: ______________________________ State: _______________ Zip Code: __________________ Phone: _________________________ Ext: ____________ Phone 2: __________________________ Email: _______________________________________________________________________________ Please designate your desired option(s):
2011-2012 Advertising Rates – MSConnection Only++
$750
Full page
$450
Half page
$250
Quarter page
3x* (each)
2x* (each)
1x
Ad Type
4x*(each)
$700
$650
$625
$400
$350
$300
$230
$215
$200
2011-2012 Grant Rates – MSConnection Only++ Exclusive Grant Per Issue ($5000)
Exclusive Grant for Year
$5000 x _____(# of Issues) = $_______
$20,000
2011-2012 Grant Rates – MS Update Only++ Exclusive Grant Per Issue ($500) $500 x _____(# of Issues) = $_______
For questions or to submit payment, please contact: Robyn M. Hirsch Programs & Services Director / Editor
760 Lynnhaven Pkwy, Ste. 201, Va. Bch., VA 23452 Phone: (757) 490-9627, Fax: (757) 490-1617 Email: robyn.hirsch@nmss.org
++ Please see 2011-2012 Advertising/Grant Rate Information document for a description of the publications, general requirements, mechanical requirements, deadlines for submission, and advertisement, logo, and payment submission information.