Philly Beer Geek - Sponsor Registration

Sponsor Registration

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Sponsor:
Contact:
Address:
City, State, ZIP:
Phone (land line):
Phone (cell):
E-mail Address:
Web URL:
Scheduled Date of Qualifying Round:
Place of Qualifying Round:
Full Address of Qualifying Round:
Time of Qualifying Round:
Registration Fee $60 (please check one):	Check Cash Visa,Master Card,Discover Do not enter credit card information on this form. Payment instructions are available after this form has been submitted.
Sponsorship Prize Submitted (please describe):
Value of Sponsorship Prize: