HIMSS NYS - Sponsorship Order Form

Sponsorship Order Form

Application:

The HIMSS New York State Chapter greatly appreciates your generosity and support as a Corporate Sponsor. Please submit the form below to begin your Sponsor Application.

After your application is submitted, a member of our team will contact you within 2 business days to process your sponsorship.

* Company Name

* Company URL

Company Logo Please include a high resolution logo with your application.

Company Contact Information:

* Primary Contact Name

* Primary Contact Phone Number

* Primary Contact Email

Secondary Contact Name

Secondary Contact Phone Number

Secondary Contact Email Address

Additional notes

File Upload (option 2) Please include additional company information including company logo, white paper, event flyer or speaker profile.

File Upload (option 3) Please include additional company information including company logo, white paper, event flyer or speaker profile.

* What is your preferred payment method?

Credit Card / Debit Card
Cash / Check