2016 ATHENA LEADERSHIP AWARD ® PROGRAM LICENSE/INVOICE Host Organization:
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
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 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) ByCorinne McWherter By Title Program and Events Manager Title DateDate
PO Box 811188 | Chicago, IL 60681 | Phone 312.580.0111 | Fax 312.580.0110 | www.athenainternational.org