Sponsorship Payment Portal

Note: All fields marked with an * are required. All other fields are optional.

Sponsorship Purpose

Event Name (as indicated on event invitation):

Event Date:

Sponsorship Level Name:

Sponsor Contact Information

First Name:

Last Name:

Email Address:

Phone Number:

Address:

Apt/Suite/Etc.:

City:

State:

Zip code:

Country:

This is my home address This is a business address

This is my billing address

Company Name

Is this credit card payment from an organization?

Company Address (if different from above):

Apt/Suite/Etc.:

City:

State:

Zip code:

Country:

Is this organization a non-U.S. entity?

Sponsorship Payment Details

Amount:

Donor Attestation

Donor Attestation for Compliance with Florida Statutes § 496.405.

By submitting this gift, the Donor represents and warrants that the Gift made to NSU is not from a “foreign source of concern” as defined by Fla. Stat. § 496.404(14). The Donor represents and warrants that it is not a government official or agency, a political party or member of a political party, an organization that is headquartered in, an individual domiciled in, an entity where the sources have twenty five percent (25%) or more ownership or control in, or an agent or subsidiary acting on behalf of a source in any of the following countries: the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolás Maduro, or the Syrian Arab Republic, including any agency of or any other entity under significant control of such foreign country of concern. The Donor agrees to fully indemnify and hold harmless NSU against any damages directly related to the Donor’s misrepresentation or breach of warranty under this paragraph.

By typing my name, I attest to the compliance with Florida Statutes § 496.405: *

I attest to the compliance with Florida Statutes § 496.405

Sponsor Agreement

I agree with the cancellation policy below

No refunds will be offered for goods and/or services provided.

By submitting this form, the sponsor agrees to the terms outlined in the sponsorship levels information sheet, including Goods and Services allocation and recognition deadlines. NSU reserves the right to allocate benefits based on the sponsorship level and payment received.

Check Payment

If you wish to pay by check instead of card, please note:

Checks should be made payable to Nova Southeastern University
Check memo: Event Name / Sponsorship

Contact

To provide guest information or for questions, contact Rhonda Ritchie:

Email Address: specialevents@nova.edu
Email Subject: Event Name

Mailing Address:

Nova Southeastern University
Advancement and Community Relations
PO Box 2217
Fort Lauderdale, FL 33303