Advertisement Request Form Advertising Order Advertiser Contact Information Business Name * Contact First Name * Contact Last Name * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Address Email * Phone * Website/URL * Digital Advertising Order Quantity: Eblast Ads * None – $0One – $325Two – $550Three – $675Four – $900Five – $1,125Six – $1,350Seven – $1,575Eight – $1,800Nine – $2,025Ten – $2,250 Number of eblast ads running in a 12-month period (max run one eblast per month). COST: $325 each (1 ads) or $275 each (2 or more ads). E-Newsletter Banner Ad Quantity: E-newsletter Ads * None – $0One – $95Two – $160Three – $240Four – $320Five – $400Six – $480 Number of e-newsletter ads running in a 12-month period (max run one e-newsletter every other month). COST: $95 each for single insertion; $80 each for multiples (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