NE HFMA Mentorship Interest Letter

2016-2017 Corporate Sponsorship Program Enrollment Form My Firm (company) would like to Enroll/Renew Corporate Sponsorship with the Wyoming Chapter of HFMA for the 2016-2017 Year. Sponsorship (June 1 - May 31st of each year)

______Platinum - $1,500 Benefits:  Exhibit Table at two Wyoming Chapter conferences upon request  Two Complimentary registrations for your company at both Chapter meetings.  Four(4) total provider coupons good for one conference registration per year.  Name and logo on Power Point at all meetings.  List of registered attendees, including name, facility and address as of two(2) weeks prior to all meetings which your firm is exhibiting.  Speaker introduction opportunity to promote your business (please limit promotion to 2-3 minutes)  Sponsor name tag for meetings.  Recognition in all newsletters  Recognition at Social event  Name and logo and link to your web-site as Platinum sponsor on chapter web site. Send Logo and link to Carol Wolf [email protected]  ½ page acknowledgement in all the WY HFMA newsletters. (send to Newsletter chair) Currently [email protected]  Business Highlight in all WY HFMA newsletters and Web site. (send to Newsletter chair and Web Chair) _ Currently [email protected]

Note: Dollar Value of this sponsorship is $2,800

______Gold - $1,200 Benefits:  Exhibit Table at two Wyoming Chapter conferences upon request  Two Complimentary registrations for your company at both Chapter meetings.  Name and logo on Power Point at all meetings.  List of registered attendees, including name, facility and address as of two(2) weeks prior to all meetings which your firm is exhibiting  Page 2 May 18, 2018

 Speaker introduction opportunity to promote your business (please limit promotion to 2-3 minutes)  Sponsor name tag for meetings.  Recognition in all newsletters  Recognition at Social event  Name and logo and link to your web-site as Gold sponsor on chapter web site Send Logo and link to Carol Wolf [email protected]  1/4 page acknowledgement in all the WY HFMA newsletters. (send to Newsletter chair) Currently [email protected]  Business Highlight in one WY HFMA newsletter. Note: Dollar Value of this sponsorship is $1,900

______Silver - $1000 Benefits:  Exhibit Table at two Wyoming Chapter conferences upon request  One Complimentary registration for your company at both Chapter meetings.  Name and logo on Power Point at all meetings.  Sponsor name tag for meetings.  Recognition in all newsletters  Recognition at Social event  Name and logo as Silver sponsor on chapter web site Send Logo to Carol Wolf [email protected]

Note: Dollar Value of this sponsorship is $1,450

______Bronze - $725 Benefits:  Exhibit Table at One Wyoming Chapter conferences upon request  One Complimentary registration for your company at one Chapter meeting.  Name on Power Point at all meetings.  Sponsor name tag for meetings.  Recognition in all newsletters  Recognition at Social event  Name as Bronze sponsor on chapter web site Note: Dollar Value of this sponsorship is $725

______Provider - $600

 Two registrations for provider at two education meetings.  Logo and Link to sponsor home page on Wyoming HFMA web site. Send Logo to Carol Wolf [email protected]  Listing on Power Point at all meetings.  Listing in each WY HFMA Newsletter.  Sponsor name tag for meetings.  Page 3 May 18, 2018

Note: Dollar Value of this Sponsorship is $900

______Table only - $500  Exhibit Table at One Wyoming Chapter conference

 Regarding Distribution of Provider Registration Coupons & Tax Deduction: o A primary benefit for sponsors in our chapter is the opportunity to work and network with Providers at Chapter events and to encourage expanded Provider participation in our program and to attract more attendance. In order to be in compliance with hospital policies regarding acceptance of gifts, the provider registration coupons can be only used by providers and not members of your sponsoring organization. Also, you cannot assign to a specific provider due to compliance issues so they will be placed in a “Pool” for every meeting and recognition will be given to those Corporate Sponsors who had provider coupons available for that meeting. Obviously, the more coupons that your company had available, the more recognition will be given.  Important: Corporate Sponsor (non-provider) agrees to not claim these free registration coupons as a tax deduction, as it would violate HFMA National’s 501C6 status.  Sponsor registrations can also be utilized as a provider registration only. Provider coupons must be utilized prior to the end of the sponsorship year.

Pool of Provider coupons usage:  Page 4 May 18, 2018

 First come first serve basis one per year unless we have un- used coupons for the second meeting a priority list will be developed and drawn from.  Must be a Wyoming HFMA paid member  Deposit of $100 to be returned after attendance of meeting.

Payments should be made out to Wyoming HFMA Please remit to: Chad Turner – WYHFMA Treasurer 901 Adams Street Afton, WY 83110

Thank you for your support!