Advertisement Request Form Advertising Order Advertiser Contact Information Business Name * Contact First Name * Contact Last Name * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona 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 State/Province Address Email * Phone * Website/URL * Digital Advertising Order Quantity: Eblast Ads * None – $0 One – $275 Two – $550 Three – $675 Four – $900 Five – $1,125 Six – $1,350 Seven – $1,575 Eight – $1,800 Nine – $2,025 Ten – $2,250 Number of eblast ads running in a 12-month period (max run one eblast per month). COST: $275 each (1-2 ads) or $225 each (3 or more ads). E-Newsletter Banner Add Quantity: E-newsletter Ads * None – $0 One – $75 Two – $150 Three – $225 Four – $300 Five – $375 Six – $450 Number of e-newsletter ads running in a 12-month period (max run one e-newsletter every other month). COST: $75 each (Order DUE by the 10th of the month and published the 15th of the month) Brief description * Please tell us a little about your company and what you’d like to advertise. Terms of Agreement * I have read and agree to the terms published in the current AFHE Media Kit, and I understand that advertising with AFHE is subject to review and approval by the AFHE Ad Manager. Text If you are human, leave this field blank. Submit