Company Name_________________________________________________________

Address:_______________________________________________________________

city:__________________________ zip code:___________________________

Telephone Number ____________________________

Please mark the sponsorship you wish to purchase:

________ $50.00 Sponsorship:

_______ $25.00 Sponsorship:

________ $20.00 Sponsorship:

_________ $10.00 Sponsorship:

Authorized signature: _________________________________ date:___________

Ad received by member: _________________Check # rec’d _______ Cash rec’d ________

Please attach ad to this form.

Urbana Saddle Club Mailing address: P.O. Box 138, Urbana, MO 65767

We wish to thank each sponsor as our club depends upon your financial support to help support the shows and awards.