Alliance Membership & Sponsorship Form
Please review the Membership and Sponsorship Brochure at the link below.
https://bit.ly/membershipandsponsorship
Are you a new member or existing Alliance member?
*
Please Select
New member
Existing member
How did you find out about the Alliance?
*
Organization Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organizational Mission:
*
Organization website:
*
Organization logo:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Representatives
Senior Leader Representative #1
*
First Name
Last Name
Title
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Senior Leader Representative #2
*
First Name
Last Name
Title
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Communication/Marketing Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Billing Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
My Products
prev
next
( X )
PLATINUM MEMBERSHIP LEVEL
Includes Title Level Sponsorship for the Health Equity Summit, Population Health Sumit, and Live Healthy SC Conference
$
15,000
Upgrade to Partner Level Sponsorship
Platinum Members Only
$
5,000
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
5,000.00
Live Healthy SC Conference
1
$
5,000.00
Item subtotal:
$
0.00
GOLD MEMBERSHIP LEVEL
Includes Premier Level Sponsorship for the Health Equity Summit, Population Health Sumit, and Live Healthy SC Conference
$
10,000
Upgrade to Partner Level Sponsorship
Gold Members Only
$
7,500
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
7,500.00
Live Healthy SC Conference
1
$
7,500.00
Item subtotal:
$
0.00
Upgrade to Title Level Sponsorship
Gold Members Only
$
2,500
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
2,500.00
Population Health Summit
1
$
2,500.00
Live Healthy SC Conference
1
$
2,500.00
Item subtotal:
$
0.00
SILVER MEMBERSHIP LEVEL
Includes Supporter Level Sponsorship for the Health Equity Summit, Population Health Sumit, and Live Healthy SC Conference
$
5,000
Upgrade to Partner Level Sponsorship
Silver Members Only
$
9,000
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
9,000.00
Live Healthy SC Conference
1
$
9,000.00
Item subtotal:
$
0.00
Upgrade to Title Level Sponsorship
Silver Members Only
$
4,000
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
4,000.00
Population Health Summit
1
$
4,000.00
Live Healthy SC Conference
1
$
4,000.00
Item subtotal:
$
0.00
Upgrade to Premier Level Sponsorship
Silver Members Only
$
1,500
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
1,500.00
Population Health Summit
1
$
1,500.00
Live Healthy SC Conference
1
$
1,500.00
Item subtotal:
$
0.00
BRONZE MEMBERSHIP LEVEL
$
2,000
Add Partner Level Sponsorship
Bronze Members Only
$
10,000
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
10,000.00
Live Healthy SC Conference
1
$
10,000.00
Item subtotal:
$
0.00
Add Title Level Sponsorship
Bronze Members Only
$
5,000
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
5,000.00
Population Health Summit
1
$
5,000.00
Live Healthy SC Conference
1
$
5,000.00
Item subtotal:
$
0.00
Add Premier Level Sponsorship
Bronze Members Only
$
2,500
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
2,500.00
Population Health Summit
1
$
2,500.00
Live Healthy SC Conference
1
$
2,500.00
Item subtotal:
$
0.00
Add Supporter Level Sponsorship
Bronze Members Only
$
1,000
Alliance 2024 Events
Quantity
Price
SC Health Equity Summit
1
$
1,000.00
Population Health Summit
1
$
1,000.00
Live Healthy SC Conference
1
$
1,000.00
Item subtotal:
$
0.00
Save
Submit
Should be Empty: