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* 1. Please enter the following information:

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* 2. Please indicate your benefit level of interest:

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* 3. Description of your organization for the program (max of 200 words):

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* 4. Your sponsorship includes one exhibit table with wifi and electrical plug ins.  Please Answer the questions below or answer "no table" if you are not planning for an exhibit table:

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* 5. For Denali, Foraker and Fairweather Levels, your sponsorship includes an Organization Membership.  Let us know the email address to which you would like ALPHA information sent.

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* 6. For Denali Sponsorship, please list name, company and title for up to three free registrations.

For Foraker Sponsorship, please list name, company and title for up to two free registrations.

For Fairweather and Marathon sponsorship, please list name, company and title for one free registration.

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* 7. Upon acceptance by ALPHA, this agreement will become a contract between the sponsor and ALPHA for the Alaska Health Summit. The sponsoring organization and its representatives agree to abide by the information listed.

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* 8. Payment in full must be received to finalize this Sponsorship contract. This is non-refundable.
If paying by credit card, click on this link to PayPal.
 
If paying by check, mail check to Information Insights, PO Box 83070, Fairbanks, AK 99708 (must be received prior to event)

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* 9. Exact amount of sponsorship:

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