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Sponsorship Application Form

 

Organization Name:                                                                                                                                                                  

Contact:                                                                                                                                                                                         

Email Address:                                                                                                                                                                            

Address:                                                                                                                                                                                        

City/State/Zip:                                                                                                                                                                       

Telephone:                                                                                                                                                                                    

 

Annual Chapter Sponsor Options:

 

Gold - $ 1000                       Silver - $ 750                        Bronze - $ 500

 

Please send checks and application to:                        AZHAM

Attn:  Joy Everson, Treasurer

Phone:    480-342.4527                                                        P.O. Box  12485

Email:      Everson.Joy@mayo.edu                            Scottsdale,  AZ 85267

 

Sponsorship Fees Enclosed:  $                   

 

 

 

Please Make Checks Payable To:      Arizona Association Healthcare Access Management or AZHAM