Application Form for Sponsors

Name:
Company:
Type of Business:
Address:
City:
State:
Zip Code:
Fax:
Telephone:
Email:
Are You a Member of ASSE?
Enter a brief description of what type of services your company supplies.
Description must be 25 words or less. Any descriptions that exceed this limit will not be considered for submission
URL you would like to be considered for submission (i.e. http://www.yourcompany.com)
The chapter reserves the right to refuse posting of any site or information.