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Ad Request Form MBC-LEO 5th Annual Dinner Souvenir Booklet October 3 2009 Deadline September 4 2009 City of Inkster Host Community E-mail inksterhostmbc09 yahoo. com Name of Business / Company / Individual Contact s Name Address Contact s Phone Number City State Zip E mail Address PLEASE ATTACH CAMERA READY AD Black and White or Grayscale I hereby request ad space in the Souvenir Booklet for the Michigan Black Caucus Local Elected Officials Annual Fundraising Scholarship Dinner to be held on October 3 2009 at the Crowne Plaza Romulus MI Inside Front Cover Inside Back Cover Full Page Ad 1/2 Page Ad Business Card Size Ad 35 Patrons 2 names 20 Patron single name 15 Subject to Availability MAKE CHECKS PAYABLE TO Michigan Municipal League MML MAIL TO Councilman Michael Greene Dinner Chairman City of Inkster 26215 Trowbridge Inkster MI 48141 By my signature below I am requesting and affirm that I am authorized to pledge the cost of the ad and authorize you to proceed with plans for my ad for the MBC LEO Dinner Souvenir Booklet. Signature of Authorized Business Agent/ Individual / Date Printed Name of Authorized Personnel/Agent Solicitor s Telehphone Number For More Information please call Councilman Michael Greene 313 575 3552 or Carmen R* Mitchell 313 562 7947 For Use by The City of Inkster Host Committee Only Labor Donated. com Name of Business / Company / Individual Contact s Name Address Contact s Phone Number City State Zip E mail Address PLEASE ATTACH CAMERA READY AD Black and White or Grayscale I hereby request ad space in the Souvenir Booklet for the Michigan Black Caucus Local Elected Officials Annual Fundraising Scholarship Dinner to be held on October 3 2009 at the Crowne Plaza Romulus MI Inside Front Cover Inside Back Cover Full Page Ad 1/2 Page Ad Business Card Size Ad 35 Patrons 2 names 20 Patron single name 15 Subject to Availability MAKE CHECKS PAYABLE TO Michigan Municipal League MML MAIL TO Councilman Michael Greene Dinner Chairman City of Inkster 26215 Trowbridge Inkster MI 48141 By my signature below I am requesting and affirm that I am authorized to pledge the cost of the ad and authorize you to proceed with plans for my ad for the MBC LEO Dinner Souvenir Booklet. Signature of Authorized Business Agent/ Individual / Date Printed Name of Authorized Personnel/Agent Solicitor s Telehphone Number For More Information please call Councilman Michael Greene 313 575 3552 or Carmen R* Mitchell 313 562 7947 For Use by The City of Inkster Host Committee Only Labor Donated.

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