Sponsor Order Form Sponsor Level*Premier ($4,500 / yr)Corporate ($3,500 / yr)Partner ($2,500 / yr)Additional Sponsor OpportunitiesMeal Sponsor $1500 - Includes (1) event passEvent Bag sponsor $1000 - Includes (1) event passReception or Snack Sponsor $500 - Includes (1) event passCompany Name*Company Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Company Phone*Marketing Contact*Marketing Email Regional Contact or Listing NameThe contact name as it should appear on your sponsor page.Listing Name Email The email to use for your sponsor page.Website AddressThe website address (URL) to link from your sponsor page.Company Overview*Provide a brief company overview highlighting products and servicesCompany LogoIf available, please upload your company logoMethod of Payment*Pay Online (PayPal)Pay by CheckTotal $0.00 Once you select submit, you are agreeing to Pay by Check. Please mail your check to: SC HIMSS c/o Linda Hoover 441 Crestwood Drive Wilmington, NC 28405
