2023 Indiana Public Health Association and Health by Design Sponsorship Form

Please complete this form to sponsor the following events:

Indiana Public Health Association 2023 Policy & Advocacy Forum (January 19th, 2023)
MOMENTUM: Indiana Public Health Association 2023 Annual Meeting & Conference (April 18, 2023)
2023 Indiana Health Equity Summit (August 17-18, 2023)

Learn more about sponsorship packages and benefits HERE.

Contact kbledsoe@hbdin.org with questions.

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* 1. Contact Name

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* 2. Organization

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* 3. Mailing Address

Street Address 1

Street Address 2

City

State

Zip Code

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* 4. Email Address

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* 5. Phone Number

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* 6. Sponsorship Level

Learn more about sponsorship packages and benefits HERE.

Diamond Level ($15,000)

Platinum Level ($10,000)

Gold Level ($5,000)

Silver Level ($2,500)

Bronze Level ($1,000)

Supporter Level ($500)

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* 7. What is your preferred method of payment?

If your preferred method of payment is credit card, you may pay HERE.

Credit Card

Check

2023 Indiana Public Health Association and Health by Design Sponsorship Form

Question Title

* 1. Contact Name

Question Title

* 2. Organization

Question Title

* 3. Mailing Address

Question Title

* 4. Email Address

Question Title

* 5. Phone Number

Question Title

* 6. Sponsorship LevelLearn more about sponsorship packages and benefits HERE.

Question Title

* 7. What is your preferred method of payment? If your preferred method of payment is credit card, you may pay HERE.

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* 8. Is there any other information you want us to know about your sponsorship?

* 6. Sponsorship Level

Learn more about sponsorship packages and benefits HERE.

* 7. What is your preferred method of payment?

If your preferred method of payment is credit card, you may pay HERE.