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Newsletter Banner Ad Registration

(Please complete all fields)

Please complete this form. Email the image submissions, as well as any questions to Jeff Cantwell at jeff.cantwell@rca-usa.org.

Company Info

Company Name (required)

Contact Person (required)

Contact Title (required)

Contact E-Mail(required)

Website Address (required)

Month to begin sponsorship

Month to end sponsorship

Company Address (required)

Company City (required)

Company State (required)

Company Zipcode (required)

Company Phone (required)

Company Fax (required)

URL to link Banner Ad to (required)

Specifications:

Specifications:

RCA Members $300 per month, 10% discount for 3 months, 20% discount for 6 months - Sponsor information must be submitted in JPG or GIF formats only.(No animation, please) Size Specifications: Must be 600 X 75 pixels and file size should be under 20KB. Payment must be received before the information is posted.

Payment Details:

 1 Month: $300 2 Months: $600 3 Months: $810 (10% discount) 6 Months: $1440 (20% discount)

Method of Payment

Name on Credit Card (required)

Card Number(required)

Expiration Date MM/YY format(required)

Please make checks out to Rural Cellular Association and send to:
805 15th St.
Suite 401
Washington, DC 20005

Billing Contact (required)

Billing Title (required)

Billing Phone (required)

Billing Address (required)

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