offi ce use only 2020 top doctors plaque order form … · 2020 top doctors plaque order form show...
TRANSCRIPT
2020 TOP DOCTORS PLAQUE ORDER FORMShow your clients how much Northern Virginians value you and your practice. Order yours today!Please answer the following (print neatly to ensure accuracy) and mail or fax this form and your payment to Northern Virginia Magazine (Plaques), 14901 Bogle Drive, Suite 307, Chantilly, VA 20151 Fax: 703.288.0203. For questions or concerns please email us at [email protected] or call 703.230.3812.
Phone 703.288.0204 | Fax 703.288.0203 www.NorthernVirginiaMag.com
TO ADVERTISE CALL 703.230.2980
OR EMAIL ADVERTISING@
NORTHERNVIRGINIAMAG.COM
OFFICIAL BADGE to use for your Website
or Advertising
Plaque Information
Name (& Credentials) of Top Doctor winner to appear on the plaque
Specialty (Optional)
Practice Name (Optional)
Number of Plaques ordered ($169 each) Total
❒ If you would like to receive a complimentary digital version of your plaque for use on your website, please check here
Plaque ApprovalYou will be required to approve the plaque prior to production. Please provide contact details below of who the proof should be sent to:
Name
Phone
Billing Information
Method of payment:
Credit Card Number CVV
Expiration Date (Month/Year)
Name as it appears on the card
Billing Address: (Address, City, State, ZIP)
Shipping Address
Atten:
Shipping Address: (Address, City, State, ZIP) *no P.O. Boxes
PLEASE CHECK IF YOU ARE INTERESTED IN ADVERTISING❒ Thinking about advertising and would like rates sent over to me via email.
10.20.10
Top DocTors
A look at innovative advances
from area doctors, and how they
are making Northern Virginians
happier and healthier. Plus,
a comprehensive list of Top
Doctors from allergists to
vascular surgeons.
Women take
over World
Sarah Fraser debuts
new web show
Gypsy
BreWinG
Growing beer market
calls for teamwork
sex and the
Capital City
Ex-Politico reporter pens
steamy, fictional tale
smooth
transitions
Stay stylish
winter to spring
Dr. SuSan boylan
Radiation Oncologist
Top 882
Radiation Oncologist
Best2013
MudrooMs, The New, Bold Statement Space
NortherN VirgiNiaNs Of The Year
Nab Summer’S Hottest Hat StyleSCiCadaS, eat them
Before they eat you
Yoga Studio
Specialty Grocer
Singles Bar
Girls’ Night Out
Vintage BoutiqueBoutiqueBest
2013
MudrooMs,The New, BoldStatement Space
NortherNVirgiNiaNsOf The Year
Nab Summer’SHottestHat StyleS
at themhey eat you
Yoga Yoga Studio
Singles BarSingles Bar
FEBRUARY 2015
$4.95
SENIOR LIVING
Retirement
UTOPIA is Here in NoVA
STYLE
Layered Looks for Any Offi ce
EnvironmentRELISH
Drinking
& RIDING
Hit the trails for the
bike shop-cafe trendCITY SPRAWL
Neighborhood BOTCH
When a dog and
bread decide your fate
as a good neighbor
DR. PRASHANTH MALLY
KAISER PERMANENTE
Chronic
pain
Top Doctors
790+
SUFFERERS NOW
HAVE A MEDICAL
APPROACH TO GET
BACK TO LIVING
THEIR LIVES
FEBRUARY 2015
$4.95
Chronic
pain
Chronic
pain
Chronic SUFFERERS NOW
painSUFFERERS NOW
painHAVE A MEDICAL
APPROACH TO GET
BACK TO LIVING
Chronic
APRIL 2013
TOP D
OC
TOR
S
04.13 VOL.8 ISSU
E 4
FEBRU
ARY 2015
02.15 VOL.10 ISSU
E 2
www.NorthernVirginiaMag.com
0215_FC.indd 1
1/14/15 10:20 AM
Phone 703.288.0204 | Fax 703.288.0203 | www.northernvirginiamag.com
TO ADVERTISE CALL 703.230.2980 OR EMAIL [email protected]
Offi ce use only
Approval Code: Sales Rep: Date Processed: Invoice#
❒
❒ ❒ ❒
PLEASE CHECK IF YOU ARE INTERESTED IN ADVERTISING:Thinking about advertising and would like rates sent over to me via email.
Name Phone
Credit Card Number Expiration Date
Name as it appears on the card
Billing Address: (Address, City, State, ZIP)
Atten:
Shipping Address: (Address, City, State, ZIP) *no P.O. Boxes
Name of Top Financial winner to appear on the plaque Quali� cations/Certi� cations (Optional)
Company Name (Optional)
Number of Plaques ordered ($169 each) Total
If you would also like to receive a complimentary digital version of your plaque for use on your website, please check here ❒
$
/
Method of payment:
OFFICIAL 2015 TOP FINANCIAL PLAQUE ORDER FORMPlease answer the following (print neatly to ensure accuracy) and mail or fax this form and your payment to Northern Virginia Magazine (Plaques), 14104 Newbrook Drive Chantilly, VA 20151 Fax: 703.288.0203. For questions or concerns, please email us at [email protected] or call 703.288.0204.
Plaque Information
Plaque Approval
Billing Information
Shipping Address
You will be required to approve a proof of the plaque prior to production. Please provide contact details below of who the proof should be sent to:
the only
OFFICIAL PLAQUEPlaques sold by third parties
are unauthorized and infringe Northern Virginia Magazine’s
registered trademark. Northern Virginia Magazine
is the only source for official “NorthernVirginia® Magazine
Top Doctors” plaques.
®