Sponsorship Form

Name of organization

Name of organization's representative

Position title

Address

Street Address City State / Province / Region ZIP / Postal Code

Telephone number

CC Email

Sponsorship Level (choose one)(Required)

$4,000 Diamond Level

$2,000 Emerald Level

$1,000 Ruby Level

$500 Pearl Level

PLEASE MAKE CHECK PAYABLE TO: COUNCIL OF HISTORICALLY BLACK GRADUATE SCHOOLS. FEDERAL ID NUMBER: 20-1597249.

CREDIT CARD PAYMENT OPTION IS AVAILABLE; PLEASE CONTACT DR. TYISHA HATHORN, TREASURER, DIRECTLY TO COMPLETE THIS PROCESS.

I CERTIFY THAT I AM DULY AUTHORIZED TO MAKE THIS TRANSACTION FOR AND ON BEHALF OF THE COUNCIL OF HISTORICALLY BLACK GRADUATE SCHOOLS.

This field is for validation purposes and should be left unchanged.