Sponsorship Sponsor VA HIMSS Sponsor Level(Required) Premier ($6,750 / yr) Corporate ($5,000 / yr) Partner ($2,700 / yr) Name(Required) First Last Company Name(Required) Company Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) Company Phone(Required)Marketing Contact(Required) Marketing Email Sponsor Display Name for VAHIMSS Web Site The contact name as it should appear on your sponsor page.Sponsor Display Email The email address you would like listed on your VAHIMSS Sponsor page where our members may contact your company.Website Address The website address (URL) you would like listed on your VAHIMSS Sponsor page where our members may read about your company.Company Overview(Required)Provide a brief company overview highlighting products and services. We will post this information to your sponsor page on our web site.Company LogoMax. file size: 50 MB.Please upload your company logo as you would like it to appear on your sponsor page and any promotional materials from VAHIMSS.Method of Payment(Required) Pay Online (PayPal) Pay by Check (Invoice) Total CAPTCHA Δ
