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2. Third Party/Political Organization Name:*
4. Community Electronic Sign:
5. Both Community Electronic Signs

   1. One Week - $50.00
   2. Two Weeks - $75.00
   3. Three Weeks - $100.00
   4. Four Weeks - $125.00
7. Community and Facility Electronic Signs:
8. Facility Signs And Community Electronic Signs

   1. One Week - $150.00
   2. Two Weeks - $225.00
   3. Three Weeks - $300.00
   4. Four Weeks - $425.00
10. Date to Begin *
    Date to Begin
11. Date to End*
    Date to End
13. Please note that longer advertising contracts are available, please contact 780-849-8033 or comms.coordinator@slavelake.ca for more details.
15. Prices are subject to applicable taxes
17. Sign Text *
    (Maximum 12 Words)
18. Please Include a Copy of the Logo if available.
    High Resolution JPEG and PNG are required
20. Billing Information
22. Name*
23. Email Address*
25. Address*
27. City*
28. Province*
29. Postal Code
31. Phone Number*
33. Once form is submitted a proof will be sent to the email provided above within two business days. Upon approval of proof, the advertisement will begin airing on date requested to begin.
35. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Electronic Signature*
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field