Sponsorship Enrollment
IDAHO CHAPTER HFMA
CORPORATE SPONSHORSHIP PROGRAM
TAX ID. NO. 23-7017065
My firm would like to obtain/renew our Corporate Sponshorship with the Idaho Chapter of HFMA for the fiscal year as follows:
____ Platinum
$1,400 4 Registrations ____ Gold $1,100 3 Registrations ____ Silver $800 2 Registrations ____ Bronze $500 1 Registration
Method of Payment: ____ Check (Payable to: Idaho Chapter HFMA)
| Name: | _______________________________________________________ |
| Signature: | _______________________________________________________ |
| Firm (Co. Name): | _______________________________________________________ |
| Address: | _______________________________________________________ _______________________________________________________ _______________________________________________________ |
| Telephone: | _______________________________________________________ |
| Fax: | _______________________________________________________ |
| E-Mail: | _______________________________________________________ |
Please return completed form with check to:
Carla Terry, VP of Finance
Idaho Hospital Association
P O Box 1278
Boise, ID 83701-1278