Please complete all information below and e-mail your ad for the conference program to Vicki Watson at vwatson@ncdaonline.org no later than January 20, 2017.

Sponsoring Organization
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Contact State	Choose One Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington Washington D.C. West Virginia Wisconsin Wyoming
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Company Web Site
PAYMENT Once you click on the submit button, you will have the option to pay by credit card or download an invoice and download NCDA’s W-9 form. Please select the sponsorship level: * Platinum – Awards Luncheon: $7,500 Platinum – Reception: $7,500 Gold – Conference Program: $5,000 Silver – Conference Program: $2,500 Please type 7iofh3bv into the box below before continuing *: