2016 athena leadership award ® program license/invoice host Organization:   Primary Contact:   Email Address:  

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Host Organization:      

Primary Contact:     

Email Address:      
This 2016 ATHENA Leadership Award® Program License/Invoice supersedes all prior written or oral agreements between you and ATHENA International with respect to the ATHENA Award® Program.

Please check one:  We intend to present the ATHENA Leadership Award in 2016 on      /      /2016

 We do not plan to present an ATHENA Leadership Award in 2016


$1350 annually

(flat fee)

Includes: 1 ATHENA Leadership Award Sculpture, Engraving, Shipping and handling, License rights to the program as stated in the terms & conditions, License materials, ATHENA support, exposure in our monthly eNews and website, and Invitations to ATHENA International hosted events

 I wish to purchase       additional ATHENA Leadership Award sculpture(s) at $650 each.

 I have opted to purchase an ATHENA Young Professional Leadership Award sublicense for $250

 I have opted to purchase an ATHENA Organizational Leadership Award sublicense for $250

  • This includes a recognition piece, administrative fee, shipping and handling

 I have enclosed my payment in the amount of $      

 I will call with credit card information

 I will pay online via PayPal

Please Initial
  I will send payment at a later date (10-12 weeks prior to event)

      I have read and agree to the license terms and conditions

      I understand that the ATHENA materials (inc. sculpture/awards) will be sent only upon receipt of payment.

      I agree to complete and return a sculpture order form at least 4 weeks before my event.

PLEASE NOTE: Sculptures ordered less than three weeks before your event WILL result in a $50 fee plus additional shipping fees!
Please initial, sign and return the ATHENA Award® Program License/Invoice. You will receive a signed copy for your records.
ATHENA International (Licensor) ATHENA Award® Program Host (Licensee)
By Corinne McWherter By      
Title Program and Events Manager Title      
Date Date      

Signature Signature      

PO Box 811188 | Chicago, IL 60681 | Phone 312.580.0111 | Fax 312.580.0110 | www.athenainternational.org

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