New York State Volunteer Ambulance and Rescue Association

New York City Region, Districts 4 & 18

2012 EMS Week Recognition Dinner

JOURNAL AD ORDER FORM

[_____] $175.00 Full Page

[_____] $100.00 Half Page

[_____] $ 75.00 Quarter Page

[_____] $ 40.00 Business Card

[_____] $ 20.00 Booster

Please attach a copy of your camera ready ad or a business card.
To guarantee your ad is published in the journal, please be sure to have your ad copy  submitted  by at least  April 1, 2012.

Name:_______________________________________

Phone: (_____) _____-__________

Address:__________________________________________________________

Please make checks payable to: NYSVARA, NYC Region.

Print page, complete, enclose check and return to:

NYSVARA NYC Region
2012 Volunteer EMS Recognition Dinner Committee
PO Box 116
Howard Beach, NY 11414-0116

The Dinner Chairperson is Mr. Martin Grillo, Chief of Emergency Medical Rescue of NYC. He can be contacted at (718) 474-0680. info@emsdinner.com

The New York State Volunteer Ambulance & Rescue Association was established in 1939 and is a 501 [ c] [ 3] organization.
We’re on the web at www.nysvara.org