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 – $650Three – $825Four – $1,100Five – $1,375Six – $1,650Seven – $1,925Eight – $2,200Nine – $2,475Ten – $2,750 Number of eblast ads running in a 12-month period (max run one eblast per month). COST: $325 each (1 ad) or $275 each (2 or more ads). E-Newsletter Banner Ad Quantity: E-newsletter Ads * None – $0One – $95Two – $190Three – $285Four – $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 1-3 monthly placements; $80 each for 4 or more in a 12-month period. (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 Submit
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