Personal Benefits Partner Submission Form

Unlock Growth Opportunities by Becoming a Personal Benefits Partner!
Please complete the following form to apply for Personal Benefits Partner status and unlock a world of benefits, including enhanced visibility, networking opportunities, and exclusive offers!
VNA offers a host of benefits:
- Visibility: Boost your company’s online presence with a profile, logo, and live link on the VNA website—making it easy for nurses to find and engage with your offerings.
- Networking Opportunity: Connect directly with nurses by presenting at any of our 12 chapters across Virginia.
- Promotion: Enhance your organization’s credibility with approved use of VNA Marks.
- Exclusive Offer: Showcase your company at our in-person Fall Conference with complimentary exhibit space.
Company Information
Company Name*
Company Website*
Please provide the URL you'd like to link to on the VNA website.
Company Profile

Please provide a brief description of your company.0/200
Company Logo*

Please upload your company logo (high-resolution PNG or JPEG).
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Contact Information
Name*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Partnership Details
Type of Partnership (Check all the apply):*
Partnership Contributions
Explain how your business can contribute to revenue sharing and/or offered discounted services/products to the Virginia Nurses Association or it's members.

0/250
Please provide any additional details or requirements you'd like us to consider for this partnership.
Terms and Conditions*

By submitting this form, you agree to abide by the terms and conditions set forth in the contractual agreement between your company and VNA.
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Unlock Growth Opportunities by Becoming a Personal Benefits Partner!

Company Information

Contact Information

Partnership Details

Partnership Contributions