Become a Platinum Sponsor Via Check

Please complete the form to become a Platinum Sponsor ($5,000+).

You can send a check to: IAEE, PO Box 1062, Johnston, IA 50131

To pay via credit card use this form.

* denotes a required field.

Company/Organization Name: *
Website URL: *
Address: *
City: *
State: *
Zip: *
Contact Name: *
Contact Phone Number: *
Contact Email Address: *
Scholarship Fund Donation: Make a one-time donation to our scholarship fund for students attending accredited post-secondary institutions in Iowa	Donation Amount: $ __________

Organization Members

Please list who should receive the 10 organization memberships included with this sponsorship.

For each member, include First Name, Last Name, Phone Number, and Email Address.