Corporate Sponsorship Terms: $499 / Year First Name:* First Name Required Last Name:* Last Name Required Address Line 1: Address Line 1 is not valid Address Line 2: Address Line 2 is not valid City: City is not valid Country: Country is not valid -- Select Country -- United States (US) Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belau Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba CuraÇao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Republic of Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Martin (Dutch part) Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Western Samoa Yemen Zambia Zimbabwe State/Province: State/Province is not valid Zip/Postal Code: Zip/Postal Code is not valid Email:* Email is Required Phone: Phone is not valid Company Name:* Company Name is Required Company Website: Company Website is not valid Company Phone:* Company Phone is Required Company Address:* Company Address is Required Company Address 2: Company Address 2 is not valid Company address 3: Company address 3 is not valid Company City:* Company City is Required Company State:* Company State is Required Company Zip Code:* Company Zip Code is Required Nature of Business:* Nature of Business is Required Representative #1:* Representative #1 is Required Representative #2: Representative #2 is not valid What do you sell?:* What do you sell? is Required Do you sell education or mentoring?:* Do you sell education or mentoring? is Required How did you hear about us?:* How did you hear about us? is Required By clicking the box, the applicant herein agrees to abide by all accepted standards of fairness and good business practices, to obey all federal, state and local laws and further agrees that if at any time the JaxREIA Board determines that it is not in the best interest of JaxREIA to continue the Corporate Sponsor/JaxREIA relationship, that upon written notice and return of any unearned fees, this relationship shall be terminated. The applicant further agrees to hold JaxREIA, its officers and members harmless from any action or inaction whatsoever associated with this agreement and/or participation in any JaxREIA sponsored event. I also understand that the terms of the Corporate Sponsor Program may change from time to time and agree to abide by all JaxREIA rules as set forth in bylaws, common practice and as expressed on this application and instructions. * Mobile Phone: Mobile Phone is not valid I am authorized to represent the above-named entity and I do hereby apply for JaxREIA Corporate Sponsor status and agree with all terms written above and in the Corporate Sponsor Program. * Jax REIA events may be videotaped and/or photographed and may be used in all forms of media. Applicant(s) agree(s) to allow JaxREIA to use any of the videos or photos that include their images for promotional purposes. Checking the box indicates agreement.* Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match No val Please fix the errors above
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