MIT Enterprise Forum of the Great Lakes -- Sponsorship Application

Name

Title

Company

Address

Mail Address	For Technology Review and Sloan Management Review if different from above

Telephone		Fax

E-Mail		Website

Products/Services

Please check to indicate your interest in the forum
	Entrepreneur		Investor
	Service Provider		Member-At-Large

Corporate Sponsorship
	Regular One-Year Sponsorship $500
	Regular Two-Year Sponsorship $900
	Benefactor One-Year Sponsorship $1,200
	Benefactor Two-Year Sponsorship $2,000
	Patron One-Year Sponsorship $5,000
	Patron Two-Year Sponsorship $9,000



Send check and copy of registration to: Brian Lasher Treasurer MITEF Great Lakes 617 N. Old Woodward Avenue Apt #1 Birmingham, MI 48009