APPLICATION FOR SPONSORSHIP
                                                AMERICAN ASSOCIATION OF DENTAL BOARDS
                                                ANNUAL MEETING:________________________
                                                                                                   (Date/s)
                                                Rosen Shingle Creek Resort, Orlando, FL

Sponsor Information (please print or type):
Sponsor: (Company Name): ________________________________________________________
CONTACT NAME: _____________________________ POSITION: __________________________
BY (Signature of Individual): __________________________________________________________
ADDRESS OF COMPANY: ____________________________________________________________
CITY/STATE/ZIP: ___________________________________________________________________
PHONE (Business): ____________________ PHONE (Toll free): _____________________________
FAX: _________________________________ E-MAIL: _____________________________________
WEB PAGE (for registrant materials): ___________________________________________________
PRODUCT OR SERVICE DESCRIPTION: ________________________________________________

Sponsorship Options:

___ Scientific Programs, Thursday & Friday, Oct. 7-8, 2010 $2,500 to $5,000
___ President’s Reception, Thursday, October 7, 2010 $2,000 to $3,000
___ Breakfast Forum, Friday, October 8, 2010 $2,000 to $3,000
___ Award Banquet Luncheon, Friday, October 8, 2010 $5,000

METHOD OF PAYMENT:
___ Check or ___ International Money Order (in US$) is enclosed
For Credit Card Payment: * VISA * Master Card * American Express
Credit Card No. ____________________________________ Expiration Date ___________________________
Amount Charged $___________ Name as it appears on the card ___________________________________
Authorized signature_____________________________________________

When signed below, I/We agree to abide by the entire Exhibiting Rules and Regulations of the AADB which we have read and are aware
that these Rules and Regulations and all applicable rules, regulations and stipulations of the meeting facility, are an integral part of this contract.


Sponsor Name_____________________ Signature _____________________Title______________Date_________
(Please print)


AADB Authorization __________________ Signature ____________________ Title_____________Date_________
(Please print)