This is to certify that The New York Institute for Special Education will display at its website a banner advertisment for:

Company Name:

Start Date: for a period of one year.

Company Link:
Choose one:
$150 One Page Site Sponsor $300 Three Pages Site Patron
$500 Six Pages Site Benefactor Other:

Your company has agreed to the conditions stipulated in the Sponsorship Information pages. Please submit a list of the pages to carry the banner ad.

________________________ Date:
Company Representative

________________________ Date:
NYISE Representative

This form is not for electronic submission. You can fill it out on the computer then print it. Please mail or fax to NYISE for signing.

Fax Number: (718) 519-7905 Questions? Just email us.