NYS Chapter Sponsor Registration Form

HIMSS NYS Chapter Sponsor Application

Please provide all required details to register as a sponsor
Company Name*
Primary Contact*

First NameLast Name
Contact Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Website*
Upload Company Logo

Upload a File

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Description of Product or Service Offering
Sponsorship Details
Sponsorship Level*
Additional Details, Specific Events, Questions.
Thank you for your interest in sponsorship. We will be in touch shortly to confirm the details and arrange payment.
After you submit this sponsor registration form, you will be returned to the NYS Chapter home page.
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HIMSS NYS Chapter Sponsor Application