AvScholars - Marketing Request Form

First Name:*

Last Name:*

Title:

Organization Name:*

Address 1:*

Address 2:

City:*

State/Province:*

ZIP/Postal Code:*

Country:*

E-mail:*

Phone:*

Fax:

Website URL:

Type of Organization or Business:

Please briefly describe the program, product, or service you would like to advertise.

The URL your ad would reference:

Which Sponsorship or Advertising Option(s) Are You Interested In? (Check all that apply)

	Sponsorship Levels
	Channel Advertising
	Diversity Recruitment Advertising
	My AvScholars Directories Posting
	Featured School, Employer, Organization, or Museum
	E-Newsletter Advertising
	Other:

How soon might you begin advertising with AvScholars?

How did you learn about AvScholars?*

Comments/Questions: