Registry for a New Associate Sponsor (Individual)

I would like to become an Associate Sponsor of the X Van Candidate for the X PRIZE

I am sending a check (or postal money order) for $5 to PanAero, Inc.,
      P.O. Box 223777, Chantilly, VA 20153-3777

I believe that I qualify as an Associate Sponsor since I have purchased $100
      or more of your Prepaid Calling Cards or other products.

Please fill out any of the following contact points that are appropriate:


Name


email Address

Company (if applicable)

Address

City
State
(USA)
Country (other than USA)
ZIP (or other)
Questions and/or comments:


:

Thanks for your interest and help.

Len Cormier
X Van Program Manager / tour2space Sweepstakes Manager