Type of Request* First Year Win: 2017 (Complimentary) Reneweal ($300 fee) Name of Winning Product(s) and year of win:*Example: Musical Owl by ALEX, 2013Company/manufacturer/publisher/PR firm:*Name* First Last Email* Phone*Renewal Fee Price: $300.00 Payment Method*PayPalCheckCredit card users please note: The charge on your statement may show up as "NAPPA," "L.A. Parent" or "Epstein Custom Media."Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name When paying by check, we will email your e-seal once payment is received. Make checks payable to NAPPA and send to: NAPPA 5855 Topanga Canyon Blvd., Suite 210 Woodland Hills, CA 91367* By checking here, I accept the terms of the NAPPA License Agreement Form. I understand that NAPPA seal artwork may only be reproduced with prior NAPPA approval. This request will not be processed without checking this box. This iframe contains the logic required to handle Ajax powered Gravity Forms.