Arizona Healthcare Financial Management Association (AZHFMA)

Sponsorship Application /Renewal Form

Contact Name: *
 Title:
Company Name: *
Address: *
City: *
 State: *
 Zip: *
Phone Number: *
 Fax:
Email Address: *
 Website:

Business Services Offered: (Maximum of 3)
Accounting/Auditing Services Appraisal/Valuation Services
Benchmarking Data Services Collection and A/R Recovery Services
Compliance/Fraud & Abuse Computer Software
Consulting Services Contract Management Services
Decision Support Systems/Services Document Management Products
EDI Products/Services Education Training
Energy Management Services Executive Search Firms/Staffing
Facilities Design and Construction Financial Services
Group Purchasing Organizations Healthcare Publications
Home Care Products/Services Human Resources/Employee Benefits
Insurance Products/Services Investment Banking
Investment Products/Services Managed Care Products/Services
Materials Management Office Equipment/Furniture
Online Supply Purchasing Outsourcing Services
Patient Account Mgmt/Business Office Patient Record Products/Serices
Physician Practice Acquisitions Services Physician Practice Management
Professional Member/Trade Organization Reimbursement Services
Telecommunications Equipment/Services Time and Attendance Systems

Please Select Your Preferred Sponsorship Level: *
Platinum - $2,750
Gold - $1,750
Silver - $1,250
Bronze - $500
Copper - $250
Business Services - $150