INDUSTRY COLLECTIVE REGISTRATION
Thank you for joining NPN as an Industry Collective Member! We all play a unique and valued role in the lives of NICU families and their babies and we appreciate the work you do to ensure families thrive well beyond their hospital stay.
COMPANY INFORMATION
Please complete the information below for the main point of contact for your company.
Company Name
*
Contact Name
*
First Name
Last Name
Contact Job Title/Department
*
Contact Email
*
Contact Phone Number
*
Please enter a valid phone number.
INDUSTRY COLLECTIVE LEVEL
Please select the level you wish to join. Refer to the Industry Collective information packet below for specific benefits of each level.
Download, view or print the full information packet.
*
An invoice will be sent to the contact name & email provided after this form is submitted.
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Thrive - $75,000
Empower - $50,000
Encourage - $30,000
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ADDITIONAL COMPANY CONTACTS
Your Industry Collective membership allow for up to 4 additional company contacts to be added to your membership bundle. Please provide their information below. After payment of your membership invoice, an account will be set up for each team member listed.
Team Member #1
*
First Name
Last Name
Job Title
*
Email
*
example@example.com
Team Member #2
*
First Name
Last Name
Job Title
*
Email
*
example@example.com
Team Member #3
*
First Name
Last Name
Job Title
*
Email
*
example@example.com
Team Member #4
*
First Name
Last Name
Job Title
*
Email
*
example@example.com
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COMPANY INFORMATION
The information below may be shared publicly on the NPN website and for social media posts.
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
General Company Email
*
Company Website
*
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MARKETING INFORMATION
The information below will be utilized during promotions of events, in the virtual expo booths (where applicable), banners in our event platform, social media, quarterly industry update newsletter, and online community ads (where applicable) .
Company mission
*
Company tag line
*
Hi res company logo file upload here preferably with a transparent background:
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Browse Files
Drag and drop files here
Choose a file
Cancel
of
Social Media Channels
type n/a if you do not have the specified channel
Twitter
*
Facebook
*
Instagram
*
LinkedIn
*
YouTube
*
Submit
Should be Empty: