| Prefix | Name | Title |
|---|
| Company/Organization |
| Street address |
| City | State | Zip |
| Phone | Cell | E-mail address |
| OPPORTUNITIES (please select one) |
| ☐ Presenting Partner | 25,000 SOLD Exclusive opportunity |
| ☐ Lunch Partner | 12,500 SOLD 1 opportunity |
| ☐ Heritage Partner | 10,000 SOLD 1 opportunity |
| ☐ Post-Reception Partner | 7,500 1 opportunity |
| ☐ Event Marketing Partner | 7,500 1 opportunity |
| ☐ Benefactor Partner | 5,000+ No limit on opportunities |
| ☐ Gold Partner | 1,000+ 30 opportunities (9 remain) |
| ☐ Green Partner | 500+ No limit on opportunities |
| CONTACT INFORMATION |
| Phone | Email | Mail |
| Advancement to (502) 597-5500 c (502) 892-9375 | advancement@kysu.edu | Kentucky State University 400 E. Main St. | Hume 202 Frankfort, KY 40601 |
| PAYMENT (due prior to event) |
| ☐ Check # enclosed.__________ Payable to: Kentucky State University |
| ☐ Please bill my company. PO#____________________ (not required) |
| ☐ Please Charge to my ☐ Visa [P2] Mastercard ☐ American Express |
| Cardholder's Name | Cardholder's Signature (required) |
| Card Number | Expiration Date | 3 or 4 Digit Sec. Code |
| *I understand that by providing the phone and e-mail information above on behalf of the person/company/organization specified above, I am authorized to and hereby consent for the person/company/organization to receive communication by or on behalf of the Kentucky State University or an affiliated organization. |
| Kentucky State University reserves the right to, at its sole discretion, refuse any advertising. Due to the fact that sponsorships are limited, no refunds will be granted upon acceptance of your registration. If the event is canceled due to weather or another act of God, the event will be rescheduled, or the sponsorship will be transferred to another University-approved event. All partnership levels are negotiable, and additional MOUs may be asked for pending requests. |
| At no time will Kentucky State University award any RFP or issue business to any person or firm based solely on a partnership or gift to the University. No one from the University affected by the partnership will participate in selection committees for any current or future RFP responded to by a partnering party. Ethics Policy can be found at www.kysu.edu. |