BALTNET Membership/Sponsorship Form
Yes, I would like to become a member of BALTNET and join in making vital connections between the Baltics and New England! (Check a box below for the type of membership.)
_ Individual Annual Membership - $50 _ Business/Corporate Annual Membership - $250
Name ____________________________________ Position _________________
Mailing Address ___________________________________________________
Phone _______________________ E-mail _________________________
_ Yes, I would like to support the future of BALTNET with a sponsorship gift.
_ Diamond Sponsor - $5,000 _ Platinum Sponsor - $2,500 _ Gold Sponsor - $1,000
_ Silver Sponsor - $500 _ Bronze Sponsor - $150
All sponsorship gifts will be listed on the BALTNET website (unless the donor wishes to be anonymous).
_ I/We wish this gift to remain anonymous.
_ This gift is being made in memory of __________________________________________________.
If you prefer to designate your sponsorship gift to a specific project please check one or more of the boxes below.
_ Academic Exchange _ Innovative Projects Design & Implementation
_ International Collaboration & Research Programs _ Professional & Cultural Exchange
THANK YOU FOR YOUR SUPPORT AND GENEROSITY!
Please make your check payable to BALTNET, Inc., and mail with this form to: Mrs. Regina Ziurys, Treasurer, 176 Amherst St.,
Wethersfield, CT 06109 Phone: 860-529-7339