Contact Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Desired Ad Level *

Full Page ($350)

1/2 Page ($200)

1/4 Page ($100)

Individual Listing ($100-$200)

Do you need us to design your ad? *

The finished size of the brochure will be 5.5” x 8.5”. Art requirements are 300dpi, jpeg or pdf format. See the previous page for exact dimensions for each level.

Yes (add $20 to total)

No, we will email the artwork by Dec 17, 2021 to info@uahistory.org