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    Sponsor Registration

    Thank you for your interest in our Corporate Sponsor Program. Please complete the form below to submit a sponsorship request or click here to Register by Mail.

    Payments can be made in lump sum or three equal installments. Sponsor response form and initial payment must be received by August 10, 2011. The second installment is due by November 1, 2011. The third installment is due by February 1, 2012. You will receive an invoice for the installments.

    For more sponsorship registration information, please contact:

    Jill Burton
    VP of Sponsorship
    sponsorship@alabamahfma.org

    Sponsorship Registration Form

    Complete this form by August 10, 2011

    Sponsorship Level:
    Diamond Gold Silver Bronze Provider
    Details
    Sponsor
    Websitehttp://
    Address
    City
    State Zip
    Phone
    		    
    Contact
    Name
    Title
    Email*
    Phone
    Fax

    Check all of the Products/Services offered by this Sponsor
    Accounting/Auditing Services Health Information Management Services
    Appraisal/Valuation Services Healthcare Legal Services
    Benchmarking Data Services Healthcare Tax Law
    Capital Equipment Purchasing/Leasing Home Care Products/Services
    Charge Capture and Defense Auditing Human Resources/Employee Benefits
    Chargemaster Products and Services Information Systems
    Clinical Documentation Improvement Insurance Products/Services
    Coding / Documentation Validation Managed Care Products/Services
    Collection and A/R Recovery Services Materials Management
    Compliance/Fraud and Abuse Medicaid Eligibility
    Computer Software Non-recourse purchaser of nonperforming receivables
    Consulting Services Online Bill Pay and Bill View
    Decision Support Systems/Services Outsourcing Services
    Document Management Products Patient Accounts Management/Business Office
    EDI Products/Services Patient Record Products/Services
    Education/Training Patient Statement Print and Mail Services
    Executive Search Firms Physician Practice Acquisitions Services
    Facilities Design and Construction Physician Practice Management
    Facilities Management Reimbursement Services
    Financial Planning Models Staffing
    Financial Services Telecommunications Equipment/Services
    Group Purchasing Organizations

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