This page may not work correctly in your current browser, Internet Explorer. We recommend changing to a more modern browser before viewing this page. We recommend Chrome, Firefox, Safari, or Edge. CIVIC Program Day Sponsorship Program Day Sponsorship: $1500 sponsorship, sponsor logos on CIVIC’s website and social media pages, sponsor logo on program day materials, the opportunity to address the CIVIC program participants during one of the sessions. For a limited time, the program day sponsorships will also include a quarter page ad in the special CIVIC Inside Business insert published in November. Please fill out the form below to complete your sponsorship registration and payment. We are so appreciative of your support of the CIVIC Leadership Institute. If you have any questions or for additional details on how to get involved please email Sarahjane.kirkland@civichr.org. Sponsorship Amount: First Name: Last Name: Company: Email: Phone: Address: Address Line 2 City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia 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 Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix Billing Information Payment method: Credit Card Pay Later E-Check payments can only be processed from United States banks. Would you like to pay by check? Please check the box below send your check to: CIVIC Leadership Institute 4211 Monarch Way, Suite 116 Norfolk, VA 23508 Credit Card Number: Card Expiration: 01 02 03 04 05 06 07 08 09 10 11 12 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 Credit Card CVV2: Cardholder First Name: Cardholder Last Name: Billing Address: Billing Address Line 2 City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia 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 Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Captcha NOTE: Please only click the 'SUBMIT' button once. Your payment may take time to process. I will mail a check to the CIVIC Leadership Institute NOTE: Please only click the 'SUBMIT' button once. Your payment may take time to process. Neon CRM by Neon One
