DR. GLADYS BROWN WEST EXHIBIT SPONSORSHIP Name(Required)As you would like it to appear for recognitionSponsorship Level(Required) Exclusive Underwriter – $180,000 Co-sponsor – $100,000 Believer – $50,000 Mapper – $25,000 Tracker – $10,000 Path Finder – $5,000 Traveler – $2,500 Supporter – Below $2500 Supporter Level Amount(Required) Contact(Required)Title(Required)Company(Required)Address(Required) Street Address City State ZIP / Postal Code Home/Office/Cell Phone(Required)Email Address(Required) Payment Method(Required) Check Credit Card Checks to be made out to: National Center of Women’s Innovations. 1100 Wythe Street, #151 Alexandria, VA 22313 NOTE: Enter “NCWI” in memo line.Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name Total Enclosed/To Be Charged Wire transfers are welcome! Call or email Jane Plitt, Board Chair-National Center of Women’s Innovations, for instructions: jane@womensinnovations.tempurl.host or (757) 656-9870.
