Delegate Name (If Applicable) *

First Name

Last Name

Company Name (If Applicable) *

First Name

Last Name

Name / Contact Person *

First Name

Last Name

Cell Phone *

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Checkbox *

Ad Type (Please select only 1 per submission) NOTE: If you are supplying artwork for the ad, please stay within the image area indicated above. If you require an ad to be created for you, please submit a spell-checked” document wiht the text you want included and photos/images you would like used. Please be sure all photographic images are high resolution (300 dpi) and are sent as jpeg files. You may also send photographs to be scanned in, however, make sure they are sharp photos and are not blurry or scratched. Please submit all files (ads, artwork, text, and photos) to Peggy LaCroix at MissPYLProgram@gmail.com. Please submit form & ad artwork by January 5th, 2025.

$75 Business Card (3.7" wide x 2.5" tall)

$150 Quarter Page (3.7" wide x 4.7" tall)

$250 Half Page (7.5" wide x 4.7" tall)

$500 Full Page (8.5" wide x 11" tall or 8.625" x 11.25" with full page bleed)

Name on Debit/Credit Card *

First Name

Last Name

Billing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country