Junior Achievement of Southwest New England

Presenting Sponsor

Premier Sponsor

Platinum Sponsors

Use this form to register for the Hartford Business Hall of Fame and/or to reserve ad sponsorship space.

Complimentary Valet Parking available in front of The Hartford Club Entrance

Registration Deadline is February 27, 2012

* Required Field

First Name* Last Name* Title

Company Name*

Street Address* City* State* Zip*

Phone (with area code) * Fax Email *

Contact Name (if different than above)

First Name Last Name

Phone (with area code) Fax Contact email

We support this event in honor of:

______________________________________________________________________________________________

Event registration and reservation:

Please complete all applicable fields in this section

--Please reserve tickets at this level: * Clik here to review levels of support.

-I am / We are unable to attend, however, please accept a donation in the amount of $ to help offset the cost of students and educators who attend.

All but $75.00 per person is deductible as a charitable gift.

______________________________________________________________________________________________

Reserve ad sponsorship space:

______________________________________________________________________________________________

Payment Method: *

Please invoice me in

To pay by credit card, please contact Mary Jane Lund at 860-525-4510

Black tie optional

Thank You for Your Support of Junior Achievement