Sponsorship Payment

Please select which sponsorship you would like.

Qty	Amt	Title
	$1,950.00	Annual Chapter Sponsorship
	$500.00	Annual Event Exhibiting Sponsor
	$200.00	Annual Event Regular Sponsor
	$300.00	Luncheon Program Sponsor
	$750.00	Ski Trip Sponsor

First Name:

Last Name:

Company Name:

Address:

City:

State:

Postal Code:

Country:

Telephone:

Email:

PAYMENT DETAILS
Please select your method of payment and provide billing information if paying by credit card. Fields marked with are only required for that specific payment type.

I prefer to pay by Credit Card

Card Type:

Your Name
(as it appears on the card):

Card Number:

Billing Zip:

Expiration Date:

I prefer to mail a check

MAIL-IN CHECKS ONLY
A printable confirmation will be displayed upon completion. Please print and mail it with your check to:

SMPS Colorado
P.O. Box 630964
Littleton, CO 80163-0964

PAYMENT AUTHORIZATION
I hereby give SMPS Colorado permission to charge my credit card for the items selected above.

I have read and agree to these terms.

REVIEW AND SUBMIT
Please review your information above and click "submit" below to securely process your payment to SMPS Colorado.