NICD Website & NICD Magazine Ad Request

* Contact person (Full name)

Phone #

* VERY IMPORTANT INFORMATION- Please read all of this before proceeding: Please use the appropriate box(s) below- The first box is for a website ad, the second box is for an NICD Magazine ad. Please write your ad exactly as you want it to appear, making sure you place your website address, email address (If this is what you want) or other info. The boxes will automatically bounce down to the next line- 56 characters per line for the website & 27 characters per line for the magazine. (Keep in mind that prices will be affected if your ad is more than 3 lines: Additional lines will cost more).

NOTE: Typically 56 characters (Including spaces and punctuation marks & without caps) will fit on the NICD website & 27 characters (Without caps- Including spaces and punctuation marks) will fit on the NICD Magazine.

Website Ad:

NICD Magazine Ad:

* Please state your requested website page and/or magazine page for your ad to be posted:

NICD Magazine (Specify where below)

NICD Website (Specify page below)

Other page (Specify below)

Specify

Do you want a banner?

Yes- I have one to submit (We will contact you regarding your banner)

No- I'd like you to create one

What type of banner do you want? (Include items like an extra thick border, etc.)

Static (None moving banner)

2 Level animated banner (Provides more information to be listed)

Multi-Level animated banner

What would you like your banner to say?

* Please state when you would like your ad to start, the length of time to run the ad, if you want multi ads or your ad placed on more than one page(s) and what pages you would like to see your ad posted:

Please include any other information here:

Once we have received this form we will contact you to arrange payment. Note: We do not accept credit cards, PayPal or any other types of payments other than check or money order.

* Indicates Response Required