IM4US 2019 Conference Sponsor/Exhibitor Application
Official Sponsor Name
Company/Organization name or first and last name if individual as it should appear on marketing materials
*Commercial Interest (corporations only)
Is your corporation a commercial interest? A commercial interest is any entity producing, marketing, reselling, or distributing health care products consumed by or used on patients, such as pharmaceuticals, supplements, medical devices, etc.
I don't know
Street Address, City, State, Zip
Enter the company or personal website of the sponsor.
Sponsor Logo (High Resolution)
Please upload a high-resolution, print-quality logo.
Sponsor & Exhibitor Interest
I am interested in...
Exhibitor Table only
Sponsoring and exhibiting
Sponsor Level Desired
Please tell us what sponsorship package you're applying for.
Education Sponsor - $7,500
Nutrition Sponsor - $5,000
Networking Reception Sponsor - $10,000
Wellness Experience Sponsor - $6,000
Research Promoter - $3,000
Scholarship Sponsor - $600+
“Powered By” Sponsor (for Technology and A/V support) - $TBD
“Refresh and Recharge Lounge” (designated area to charge laptops, phones, tablets, and more) - $2,500
Pre-event e-blast message to conference registrants and dedicated social media post - $1000
1-color logo on conference tote bag - $250
Collateral material and/or branded gift or promotional giveaway item included in tote bags - $250
In Kind Donations (goods, services, or experiences in exchange for conference registration or sponsor acknowledgement. Specify offering in the "Details" box.
Custom Conference Sponsorship (specify interest in the "Details" box)
Exhibitor Table Desired
Please tell us which exhibitor level you're applying for.
LEADER Exhibitor Table - $1,400 (by June 30th) / $1,500 (after June 30th)
ADVOCATE Exhibitor Table - $900 (by June 30th) / $1,000 (after June 30th)
SUPPORTER Exhibitor Table (nonprofit community-based orgs only) - $500 (by June 30th) / $600 (after June 30th)
Please provide details about your sponsor or exhibitor interest, if needed.
Exhibitor Name & Phone (if applicable)
If exhibiting, enter the name and cell phone number of the person who will be tabling at the conference, if known.
Representative Contact Information
Person who will be the point of contact leading up to the conference.
Enter the billing information as it should appear on invoice
Full name of the billing contact for this sponsorship
Billing Company Name
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service