Advertisement/Sponsorship Form
Turkey Directory For Arab Patients
How to use this Form:
Use one Form
per advertiser/sponsor
Type in the Form, on
screen response, (complete applicable blanks).
Press "TAB" to move between
blank spaces.
DO NOT CLICK ON "ENTER"
while completing the form. If you do that, you will close the form and
send incomplete Form!
DO NOT press the "BACK"
button because all information will be deleted if you leave this web page.
Please
click on the button that apply to you or to your organization
Your early payment guarantee your placement at top of your selected
category, first come first serve basis.
Advertisers:
Consultants
Fee
One Year: $132
3
years:
$297
5
years:
$396
Clinics
Fee
One Year: $220
3
years:
$495
5
years:
$660
Hospitals
Fee
One Year: $350
3
years:
$787
5
years:
$1050
Sponsors:
Platinum
Fee
One Year: $425
3
years:
$866
5
years:
$962
Gold
Fee
One Year: $375
3
years:
$618
5
years:
$687
Silver
Fee
One Year: $235
3
years:
$528
5
years:
$705
I would like
to order the development of an Arabic web page which include Free web site
hosting:
One time fee: $65 Sample1;
Sample2;
Sample3;
Sample4
Note: If you
order the development of the Arabic web page in addition to your directory
advertisement, we will register your Arabic web page (free of charge) at Arabic
Google which give you more promotion to Arab patients.
Samples
PAYMENT: Made in full and advance, US Dollars
Date
payment was sent/mailed
Total payment Sent $
Your check Number Your Tracking Number
(None USA Sponsors)
Deadline: October 31, 2011
Name And Contact Information:
First
Name
Middle
Name
Last
Name
Title
Business Name
Number
Street Suite #
City
State/
Country/ Zip Code
Area Code
Telephone Number
FAX Number
E-mail Address
Web Site Address
Sending
Your Advertisement/Sponsorship Form
Payment by Check (USA)
Please complete, then
print the Sponsorship Form and mail it with your check to:
Doctors' Marketing Service P.O. Box 748 , Lake Forest,
California 92609-0748
.Payment On line (None USA Sponsors)
To
send your payment online, kindly use the following account information.
You may
need your bank to help you in the electronic transfer of funds: DOCTORS
MARKETING SERVICE Routing
Number: 122201198 Account
Number: 11072547 Farmers
And Merchants Bank To send the completed form on line, click on the button below. >>> Please Review The
completed Form before you click on "Send It in". <<< .
