PROGRAM ADVERTISEMENT FORM

Mail this form with your ad and your payment, by May 7, 2002, to:
QD Conference Program Advertisements
P.O. Box 9004
Denver, Colorado 80209

Name of Company/Organization:_____________________________________________

Contact Person:_____________________________________________

Mailing Address:_____________________________________________

Phone Number:_____________________________________________

E-mail Address:_____________________________________________

Size of Ad (mark one):
____1/4 page -- $125
____1/2 page -- $200
____Full page -- $300
____Single line acknowledgment, with name and contact information only, on
"Supporters and Contributors" -- $50

Amount Due: $________

Please indicate how you are submitting your ad art and copy:
____I am enclosing a GIF file on CD-ROM, zip disk, or diskette. Filename:
____I am enclosing a JPEG file on CD-ROM, zip disk, or diskette. Filename:
____I will email a GIF to QDAds@aol.com by May 7, 2002. Filename:
____I will email a JPEG to QDAds@aol.com by May 7, 2002. Filename:
____I am enclosing a hard copy of my ad, ready for scanning.

You will also have a line on the "Contributors/Acknowledgments" page. How do you want this to read?
(Suggested format: Company Name, Website, Address, Voice Phone Number, TTY Phone Number.)

Amount Enclosed: $________
(Please make your check or money order payable to D.W.A./S.F. W.C.)