2007
Disability Mentoring Day
Pledge Form

Disability Mentoring Day 2007
October 17, 2007

↵ Yes, my company would like to participate in Disability Mentoring Day 2007 as a National Corporate Sponsor.

Sponsorship Amount: ____________________________

↵ Yes, my company would like to participate in Disability Mentoring Day 2007 by hosting mentees. Please have someone from AAPD contact ______________________________________________ (provide person's name and phone number) to give us guidance on how to do this.

Company Name: ____________________________________________
(please print name as it should appear in printed materials)

Name: ____________________________________________________

Title: _____________________________________________________

Address: __________________________________________________

City: ___________________________  State: ______  Zip: ___________

Telephone: ______________________ Fax: ______________________

Email: ____________________________________________________

Please fax this form to AAPD c/o Mariana Nork at (202) 457-0473.

If you have any questions regarding Disability Mentoring Day, or AAPD in general,
please contact the AAPD national headquarters in Washington, DC
at 202-457-0046 (V/TTY) or by email at:

2006 DMD Sponsors • 2005 DMD Sponsors • 2004 DMD Sponsors