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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. Your sponsorship includes an Organization Membership.  Let us know the email address to which you would like ALPHA information sent.

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* 4. For Denali Sponsorship, please list name, company and title for up to five free Health Summit registrations.

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

For Fairweather Sponsorship, please list name, company and title for two free Health Summit registration.

For Marathon Sponsorship, please list name, company and title for one free Health Summit registration.

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* 5. 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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* 6. 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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* 7. Exact amount of sponsorship:

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* 8. Organization description for the conference program (200 word limit):

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