Sponsor Form

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Submit Date

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 Level(Required)

Premier ($6,750/yr)

Corporate ($4,500/yr)

Partner ($2,750/yr)

Conference Special Event ($8,500)

Conference Name Badge ($5,000)

Golf Reception ($4,000)

Conference Bag ($3,500)

Conference Track ($1,500)

Conference Wi-Fi ($1,500)

Company Name(Required)

Company Address(Required)

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

Company Phone(Required)

This will be the phone number to post on the site.

Marketing Contact(Required)

This is the company representative we should contact regarding this sponsorship.

Marketing eMail(Required)

This is the email for correspondence related to sponsorship.

Regional Contact - to be posted on the site

This is the contact name that will be posted on your sponsor page as your contact person.

eMail Address - to be posted on the site(Required)

This is the email address that will be posted on your sponsor page.

Website Address - to be posted on the site

This is the website address (URL) that want linked to your sponsor page.

Description - to be posted on the website

Services provided by Company(Required)

Other Product / Services Description

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.

Method of Payment(Required)

Total Due

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

If you have trouble with the online form, you can use the PDF version by clicking HERE.