Corporate Sponsorship Form

2021-2022 Corporate Sponsorship Program: Enrollment Form

Please enroll me as an HFMA Massachusetts-Rhode Island Chapter Corporate Sponsor at the following level: *

Platinum Sponsorship Fee $6,250/$5,625*

Gold Sponsorship Fee $3,750/$3,375*

Silver Sponsorship Fee $2,500/$2,250*

*10% Early Bird Discount if application and payment received by August 1, 2021. *

Check - 10% Early Bird Discount (received by August 1, 2021)

Check - Received after August 1, 2021

Please bill me for the full amount on September 1, 2021

Please bill me in installments on Sept. 1, 2021; Nov. 1, 2021; Jan. 2, 2022; Mar. 1, 2022

If you indicated "Check" above, please indicate the amount enclosed.

Full Name *

Company *

Company Address *

City *

State *

Zip Code *

Sponsorship Contact (Full Name) *

Phone Number *

Email *

Corporate Profile & Ad Copy Contact (Full Name) *

Phone Number *

Email *