Sponsor Form - Delaware Valley HIMSS

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Become a HIMSS Delaware Valley Chapter Sponsor and showcase your products and services to providers throughout the Delaware Valley. DV 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.

Annual Sponsor Opportunities(Required)

Executive Annual Sponsor - $5,000

Corporate Annual Sponsor - $3,500

Associate Annual Sponsor - $2,750

Discount Code

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

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.

Marketing Contact Name

Contact name to post on your sponsor page.

Marketing Contact Phone

Phone number to post on the site.

Marketing Contact eMail Address

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

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