Annual Meeting 2023 Sponsor Application

Sponsor Application

Application deadline: July 3, 2023. All sponsors subject to approval by the FMA.
Company Name*
Contact*
Agency Name (if applicable)
Contact
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email Address*
example@example.com
Phone*
Authorized Signature*

Clear
Date*

MonthDayYear
Date
What sponsorship are you interested in?*

Emerald Sponsor $25,000Silver Sponsor $7,500Diamond Sponsor $20,000Bronze+ Sponsor $3,500Platinum Sponsor $15,000Bronze Sponsor $3,000Gold Sponsor $10,000
Other Sponsorship Opportunities

Lunch Sponsor and Product Theaters $15,000Conference Email Blast $1,500Registration Desk $10,000Attendee Registration Confirmation $1,000Coffee and Tea Sponsor $5,000Enhanced program listing $200Room Drop (contact us for more details)
David A. Paulus, MD Poster Symposium Sponsorship

$10,000$5,000
I am a nonprofit or government entity*
I want to contribute a prize to the "Passport to Prizes."*
ADA: In accordance with ADA requirements, if you are disabled and require special services, please check here. Someone from our office will contact you.
For a customized plan, contact Cortney Jones at cjones@flmedical.org.

Discounts are also available on multi-advertising and/or sponsorship contracts.
Please provide a 20 word description of your company's product(s) and/or service(s) with this application. Your application cannot be processed without a description. Please type or print legibly. The FMA reserves the right to edit your company's description.*
PAYMENT INFORMATION
Payment type*

CheckMasterCardVisaAMEXInvoice Me
Card #
Name on Card
Expiration Date
Security Code
Signature

Clear
Make check payable to Florida Medical Association and mail to:

Florida Medical Association, Inc.
ATTN: Cortney Jones
1430 E. Piedmont Drive
Tallahassee, Florida 32308
PLEASE NOTE
Your sponsorship will not be confirmed until payment is received. Your application will be reviewed by the FMA. If accepted, a confirmation letter will be sent to you. If you have questions regarding your application, please contact Cortney Jones at cjones@flmedical.org.
CANCELLATION/REDUCTION OF BOOTH SPACE
All cancellations and reductions of booth space must be made in writing. Cancellation or reduction of booth space may be made with a $500 fee per booth imposed prior to July 3, 2023 for the Annual Meeting.

Cancellations/reductions received after the above dates will result in 100% of the total booth fee being collected or retained by the FMA.
Should be Empty:

Sponsor Application

PAYMENT INFORMATION

PLEASE NOTE

CANCELLATION/REDUCTION OF BOOTH SPACE