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2015 Christmas Show Ad Form
2015
Christmas Program
Ad
Request
Form
(deadline Nov.
19
)
Name
Name
*
First
Last
This is the name of the person purchasing the ad.
Company Name
*
Phone Number
*
-
-
Ad Details
Ad Type
Ad Selection
*
Full page (7.5”D x 4.5”W): $199
Half page (3.75”D x 4.5"W): $120
Quarter page (1.875”D x 4.5"W): $60
Shout Out (110 characters; no images): $10
Shout out ads cannot contain more than 110 characters. If images or logos are to be included on any full, half, quarter or business card image, they must be uploaded to this form below. No images may be included in Shout outs.
Insert Ad text
*
Please limit Shout Out to 110 characters or less. -------------------SAMPLES----------------------- "Jo-Jo, It is a joy to see your passion and commitment for God shine through your dancing! ~Mom& Dad"------------------------------------------------------------------------- "We are so proud of you, Missy! Congratulations of a wonderful year!"------------------------------------------------------------------------ "Pumpkin, I'm so sorry I couldn't make it to the show! I know you will shine! Break a leg!"---------------------------------------------------------------------------------------- "Tina, you're the best sister in the world! Love, the best brother in the world"--------------------------------------------------------------------------------
Images (Ad 1)
*
Yes
No
Image File (Ad 1)
*
Max file size: 20MB
Please upload an image that is
Choose One
*
Yes, I would like to place a second ad request using the same payment information (as indicated below)
I am placing one ad request.
I would like to place more than two ads. I would like the same form of payment on each ad request, and my additional text and program ad requests, along with the total cost are indicated in the comment box below.
Ad request #2
Ad Options
*
N/A
Full Page ($199)
Half Page ($120)
Quarter Page ($60)
Shout Out - No images ($10)
Ad #2 Text
*
Payment Information / Agreement
Payment Preference
*
Credit Card on File
Cash/Check (see front desk)
Email
*
I agree that I wish to place an ad in the 2015 MMDCO Christmas program. The fee of
$199- full page, $120-Half Page, $60- Quarter Page, or $10-Shout Out
will be charged to the Credit Card on file at Modern Messages, or check/cash payment will be made at the desk by
November 26 , 2015.
If payment is not submitted, I understand that my ad request may not be fulfilled in the 2015 Christmas Production Program.
Acceptance of Payment Terms
*
I accept payment terms
Additional Comments / Ad Details
*
Submit