1 Start 2 Preview 3 Complete Sponsorships are available on a first-come, first-reserved basis by completing and submitting this Support Application. Upon receipt of the application and indication of payment method, an email will be sent confirming requested sponsorship item(s). Sponsoring Organization & Contact Information Sponsoring Organization * Use upper and lower case letters exactly as you want your organization's name to appear in conference materials and signage. Organization Website * Please provide your organization's website URL for inclusion in promotional materials, if applicable. Contact Name * Company representative to receive all information regarding the sponsorship. Contact Title/Position * Email * Contact's email address. Email Confirmation * Please re-enter your email address. Phone * Sponsorship Items & Payment Information Events and Networking Functions Lunch, $2,500 Continental Breakfast, $1,500 Break, $1,500 Attendee Items Conference Tote Bags (SOLD) Conference Portfolios, $1,500 Water Bottles or Tumblers, $1,500 Welcome Gift, $150 sponsor fee + item cost Conference Note Pads, $750 Lanyards, $750 Conference Pens, $500 Advertising Items Wi-Fi, $1,500 Email Campaign, $1,000 each Registration Bag Insert, $500 Mobile App Icon, Home Page, $1,000 Mobile App Icon, Second Screen, $750 Mobile App Banner Ad, $500 Mobile App Push Notification, $500 General Support Select this option if you are not exhibiting or purchasing a sponsorship item. General Conference Support, $1,500 Not Applicable Method of Payment * Check all that apply. Credit Card Check Wire Transfer N/A-No Payment Due Coupon Code Make checks payable to OptumHealth EducationFederal Tax ID: 30-0238641Mail to:OptumHealth EducationAttn: Bethany SeversonMN101-W80011000 Optum CircleEden Prairie, MN 55344(A mail service that provides tracking information is recommended.) You indicated payment by credit card. Preview your application and then click the submit button to complete the application process. Instructions to process your credit card payment will be provided on the next screen. Coupon Code * Please enter your coupon code. If there is a balance due, also select the applicable form of payment (check or credit card). If paying by credit card, enter the code during checkout. Acknowledgement By applying for a sponsorship item(s), the applicant agrees to abide by all Terms and Conditions contained in the Supporter Prospectus. Message/Comment to OptumHealth Education Leave this field blank
