HIPAA COW Annual Sponsor Application Form
Thank you for your interest in HIPAA COW Sponsorship. Please complete the application form in its entirety. Once approved, you will receive an invoice for your selected sponsorship level. We greatly appreciate your support!
Organization Name
Organization Description (Please include how products/services are HIPAA related.)
Primary Contact Name
First Name
Last Name
Job Title
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Level of Sponsorship
Gold - $1500
Silver - $1000
Bronze - $500
Organization logo (JPG or PNG files)
Browse Files
Please upload a logo digital file for the website and promotional materials.
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