2013 College Basketball Awards Registration Form

1. Sponsorship*
   $10,000 - The Diaper Dandy
   $5,000 - The All-American
   $2,500 - The Frosh
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2. Full Company Name*
   Please let us know your name.
3. Your Full Name*
   Please let us know your name.
4. Address*
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5. City*
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6. State*
   Alabama Alaska Arizona ArkansasCalifornia Colorado Connecticut DelawareFlorida Georgia Hawaii IdahoIllinois Indiana Iowa KansasKentucky Louisiana Maine MarylandMassachusetts Michigan Minnesota MississippiMissouri Montana Nebraska NevadaNew Hampshire New Jersey New Mexico New YorkNorth Carolina North Dakota Ohio OklahomaOregon Pennsylvania Rhode Island South CarolinaSouth Dakota Tennessee Texas UtahVermont Virginia Washington West VirginiaWisconsin Wyoming Invalid Input
7. Zip*
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8. Phone Number*
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9. Your Email*
   Please let us know your email address.
10. Payment Method
    Check
    Credit/Debit
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11. Card Type
    Visa/MCAmerican ExpressDiscoveryOtherInvalid Input
12. Cardholder's Name
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13. Credit Card #
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14. CC Exp
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15. Security Code
16. Requests / Comments