Program Ad Submission Form

ACOE Region 4 After School Bridging the Bay Conference
Balboa High School, 1000 Cayuga Ave, San Francisco, CA 94112
January 31 - February 1, 2014

All ad submissions are due by Monday, December 16, 2013.

Please fill out the following form completely and mail your check, along with a a hardcopy of your artwork and email a softcopy of your artwork to Freddie Hendrix.

Checks payable to ACOE, to:
Freddie Hendrix, ACOE
Region 4 After School Programs
313 W. Winton Avenue
Hayward, CA 94544

Email:
fhendrix@acoe.org

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* 1. First Name:

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* 2. Last Name:

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* 3. Title:

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* 4. Business/Organization Name:

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* 5. Non-profit 501(c)(3) number:

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* 6. Address:

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* 7. City:

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* 8. State:

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* 9. Zip Code:

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* 10. Email:

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* 11. Phone Number: (Please list the best number to reach you at)

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* 12. I would like to be a Sponsoring Exhibitor:

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* 13. In what file format will you submit?

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* 14. I will mail a check in the amount below to the ACOE office at: Freddie Hendrix, ACOE, Region 4 After School Programs, 313 W. Winton Avenue, Hayward, CA 94544

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