Annual Pictorial Roster
Advertising CONTRACT
Company Agency (if applicable)
Contact(s)
Mailing Address Billing Address (if different)
Telephone Fax
Email Address Website
Signature Date
Credit Card
Visa
Mastercard
Discover
American Express
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Card #
Amanda Edmondson
Dir. of Communications & Marketing
Greater Louisville Medical Society
328 E. Main St. Louisville, KY 40202(502)
736.6330 Fax (502) 581-9022
[email protected]
Expiration
Name on Card
Billing Address
The above information is used to secure your ad placement. Your credit card will be charged if balance is not paid within 30 days following the billing date. Any unpaid
balance after 30 days will be charged interest at the rate of 1½ % per month (18% per annum). You may charge by credit card if you prefer.
Signature for contract confirmation
Signature to charge credit card
SIZE
RATE
Full Page $1075
Half Page $775
Quarter Page $550
Special Position $1875-5500
Tab Page Full $3150
Tab Page Half $1875
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Circulation: 10,000