Sponsor Form - North Carolina HIMSS

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Submit Date

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Old Sponsor Level(Required)

Annual Sponsor

Conference Sponsor

Regional Event Sponsor

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Fiscal Year

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Payment Cleared

Yes

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Paid Amount

Become a HIMSS North Carolina Chapter Sponsor and showcase your products and services to providers throughout the state of North Carolina. NC HIMSS works to shape the healthcare industry through encouraging the use of technology and promoting public policies that will improve healthcare delivery. Please complete the form below to sign up.

Sponsor Types(Required)

Annual Sponsor

Conference Sponsor

Regional Event Sponsor

Select one or more.

Annual Sponsor Opportunities(Required)

Premier Annual Sponsor - $6,750

Corporate Annual Sponsor - $4,500

Partner Annual Sponsor - $2,750

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Discount Code

Conference Sponsor Opportunities(Required)

Special Event Sponsor- $8,500

Speaker and VIP Reception Sponsor: $5,000

Name Badge Sponsor - $5,000

Conference Bag Sponsor: $3,500

Room Sponsor: $1,500

WiFi Service Sponsor: $1,750

Regional Sponsor Opportunities(Required)

Winter Dinner Event Exclusive Sponsor - $4,000

Winter Dinner Event Co-Sponsor - $2,000

National HIMSS Reception Co-Sponsor - $5,000

TopGolf Networking Event Exclusive Sponsor - $5,000

TopGolf Networking Event Co-Sponsor - $1,500

Company Details

Company Name(Required)

Company Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Company Contact Name(Required)

Company representative we should contact regarding this sponsorship.

Company Contact Phone(Required)

Phone number for correspondence related to sponsorship.

Company Contact eMail(Required)

Email address for correspondence related to sponsorship.

Company Logo

Max. file size: 8 MB.

Hi Resolution image (EPS, AI, or other) to create your logo image for the site and other collateral material.

Annual Conference Sponsor Promotion Details

Marketing Contact Name(Required)

Contact name to post on your sponsor page.

Marketing Contact Phone(Required)

Phone number to post on the site.

Marketing Contact eMail Address(Required)

Email address used (not posted) to forward leads from your sponsor page.

Website Address - to be posted on our site

Website address (URL) to link to your company from your sponsor page.

Company Description - to be posted on our site

Company details to be posted on your sponsor page.

Services provided by Company(Required)

Other Product / Services Description

Payment Details

Method of Payment(Required)

Once you select 'Submit', you will be sent an email with details on where to send your check.

Total Due