MCSA logo
Sponsor Sign-Up Form
TEAM SPONSOR $100 Team
Company Name:
Primary Contact:
Phone:   Fax:
Address:
City:   Zip:
Website Address:
Email:
Web Site Info: include information about your business
Coupon Book Info: (if you would like to include a coupon, attach logo, etc, if available): For example, "Coupon good for $2.00 off next dry cleaning bill".

If paying by check, please fill out this form and mail to MCSA / P.O. Box 438 / Centereach, NY 11720
Please make checks payable to "MCSA".

For Credit Card, enter information below.
VISA   MASTERCARD
Card Number:   Exp Date: (mm/yy)
Billing Info:
Street Address:
City:   State:   Zip: 

    

If by mail, send check or credit card information, along with this form to:
MCSA / P.O. Box 438 / Centereach, NY 11720.