Sponsorship Form
Neurosurgery Patient Education - Arabic Language

 How to use this Form:
Use one Form per sponsor
Type in the Form, on screen response, (complete applicable blanks). 
Press "TAB" to move between blank spaces. 
DO NOT CLICK ON "ENTER" while completing the form. If you do that, you will close the form and send incomplete Form!
DO NOT press the  "BACK" button because all information will be deleted if you leave this web page.

I would like to List our  clinic at the following 10 Arabic Neurosurgery patient education web Sites:
Spine Basics Low Back Pain Backpack Safety Herniated Disk Neck Pain
Neck Sprain Spinal Fusion Lumbar Spinal Stenosis Cervical Spine Stroke

Additional Titles:
Kindly send a list of suggested titles for future editions of "Neurosurgery - Arabic language patient education"

Sponsorship Fees:

Sponsorship Categories: Please click on your category of choice: Sample

Platinum: $400/yr
Gold $320/yr
Silver: $240/yr
Standard: $160/yr


    1. USA Dollars, Checks only, no credit cards.
    2. Orders are Paid in full and in advance by checks drawn on American banks.
    3. Check Number (US Advertisers) 
    4. NONE USA Advertisers
      You may pay by wire, electronic transfer of funds (
      please see - Sending The Advertisement Form, below)
    5. On Line Tracking  Number (None US Advertisers) 
    6. Payment Date 

 Important Note:

  • Your business name plus a link to its web site will appear on all sponsored web sites. Sample
  • Contact DMS about your special projects: Arabic language web sites, marketing, communications... etc.

Name And Contact Information:

First Name   M.I.   Last Name
Business Name
Number  Street  Suite #
State/ Country Zip Code
Area Code
Telephone Number
FAX Number 
E-mail Address
Web Site Address 

Sending The Sponsorship Form

Please complete, then print the Order Form and mail it with your check to:
Doctors' Marketing Service
P.O. Box 748 , Lake Forest, California 92609-0748

E. Mail  ceo.consultant@gmail.com

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