Sponsorship Participation Form
INET 97 Sponsorship Participation Form

This form allows you easily to become a sponsor of the INET 97 conference. Please note that this page only works if your browser supports forms.

If you cannot or do not want to use this form, you may alternatively print out this document and fax it to Torryn P. Brazell, Director of Conferences, 703.648.9887, to confirm your participation.

Your company will be invoiced and payment will be expected in full within 30 days to confirm sponsorship event.


Our company would like to be a Donor (US $150,000 +) Principal Sponsor (US $75,000 to $149,999) Sponsor (US $25,000 to $74,999) Contributor (US $10,000 to $24,999) (Sponsorship level is determined by adding the total of sponsored events and contributions.) Please reserve the following sponsorship event(s) for our company: Event: Investment: Event: Investment: Event: Investment: Total Contribution (includes Sponsorship Investments): (All payments must be in United States Dollars.)
Sponsor Information: First Name: Init./Middle Name: Family Name: Your title: Your organization: Your address: City: State or Province: Postal Code: Country: Telephone Number: Fax Number: Email address: URL:

Payment Method:

  1. Credit Card.
          Mastercard
          Visa
          American Express
         Credit Card Number: 
    
         For credit cards only:
             Expiration Date:    
             Name on Card:       
             Do we have your authorization to charge the indicated total 
             against your card number?  (Type YES) 


  2. Wire Transfer
       Riggs Bank of Virginia    ABA number: 054000030
       950 Herndon Parkway       Account Number: Internet Society 14 838 710
       Herndon, VA  20171
       USA
        Please indicate your name on the wire transfer
    

  3. CyberCash Secure Payment Service
    The Cybercash Secure Payment System will encrypt your financial credit card information for private transmission over the Internet. To make use of Cybercash, you will need to download a free wallet.

  4. Send me an Invoice
        Please make sure you entered a fax number or mailing address above