Sponsorship Online Registration - Step 1 of 3

Please complete the sponsorship application form or complete the PDF application and submit with payment.

* Indicates Required Information

Contact Information
COMPANY NAME:*
  
(as it will appear in promotional material)
CONTACT FIRST NAME:*  
CONTACT LAST NAME:*  
CONTACT POSITION:*  
ADDRESS:*  
CITY:*  
PROVINCE:*  
POSTAL CODE:*  
PHONE:*
(with area code)		  
FAX:  
EMAIL:*  
CONFIRM EMAIL:*

  
WEBSITE ADDRESS:  

Select Your Sponsorship Category *
GOLD $10,000
SILVER $5,000
BRONZE $2,500
Other Amount  

Payment
We will send a cheque for the sponsorship amount.
Please invoice the address listed above.
Name of the authorized company representative:  
Position:  
Payment can be made payable to CEO Inc. and mailed to:
The Good Samaritan Society
c/o CEO Inc.
#101, 10306-112 Street
Edmonton, AB T5K 1N1
Note that sponsorship benefits will commence once payment has been received.