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 Actuarial Services
Appraisal/Valuation Services Benchmarking Data Services
Capital Equipment Leasing Coding/Documentation/Chargemaster
Collection and A/R Recovery Services Compensation/Employee Benefits
Compliance/Fraud & Abuse Computer Hardware
Computer Software Consulting Services
Contract Management Services Debt Restructuring
Decision Support Systems/Services Document Management Products
EDI Products/Services Education Training
Electronic Health Records/Info Exchange Eligibility/Denials Management
EMR Implemetation/Optimization Executive Search Firms/Staffing
Facilities Design and Construction Financial Planning
Financial Services Group Purchasing Organizations
Healthcare Publications Home Care Products/Services
Housekeeping/Food Service Human Resources/Employee Benefits
ICD-10 Information Technology
Insurance Products/Services IT Infrastructure
Investment Banking Investment Products/Services
Legal Services Managed Care Products/Services
Materials Management Mergers and Acquisitions
Operations/Clinical/Performance Mgmt Outsourcing Services
Patient Account Mgmt/Business Office Patient Record Products/Serices
Physician Practice Acquisitions Services Physician Practice Management
Professional Member/Trade Organization Property/Plant Equipment/Supplies
Quality/Patient Safety RAC Services
Reimbursement Services Retirement Planning
Revenue Cycle Risk Management
Strategic Advisory/Capital Planning Supply Chain
Telecommunications Equipment/Services Temporary Staffing
Time and Attendance Systems Treasury Services
Used, New and Refurbished Equipment

Please Select Your Preferred Sponsorship Level: *
Platinum - $3,000
Gold - $2,000
Silver - $1,500
Bronze - $750