Sponsorship Request Form - Wisconsin Healthcare Engineering Association

"*" indicates required fields

2027 WHEA Sponsorship Form

Organization Name:*

Website

Address*

Street Address City State Zip

Logo Upload

Please upload your company logo.

File*

Max. file size: 100 MB.

Main Sponsorship Contact

Main Sponsorship Contact*

First Last

Phone*

Email*

Marketing Contact

This person will be responsible for coordinating directory content, advertisements, social media posts, and other marketing-related sponsorship benefits.

Is your marketing contact the same as your main sponsorship contact?

Yes

If your marketing contact is the same as the main contact the following questions can be left blank.

First Last

Sponsorship Selection

Price*

Platinum Sponsorship - $5,000.00 (8 available)

Gold Sponsorship - $2,500.00

Silver Sponsorship - $1,000.00

Sponsorship is not guaranteed, you must first be confirmed through the Sponsorship Committee. If you register with a credit card, your card will be charged. You will be notified if you have been accepted as a sponsor by the end of the year.

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

2027 WHEA Sponsorship Form

Logo Upload

Main Sponsorship Contact

Marketing Contact

Sponsorship Selection

Section Break