Partnership Agreements with Modern Healthcare

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Partnership Proposal Form

Partnership Proposal Form

Thank you for your interest in a media partnership with Modern Healthcare.

To help us determine if a partnership would be an appropriate fit for both parties, please complete the form below and you will receive a response shortly.

All of the information below is required.

Contact Name:

Title:

Organization:

Phone:

Fax:

Email:

Event Name:

Event Date:

Event Location:

Event Website:

Event Topic:

(100 words or less - describe the main focus of the event, type of audience
you will attract, etc.)

Why do you feel this would be a good event for Modern Healthcare to sponsor?

Size of Event:

Please estimate the number of attendees you expect.

Audience Make Up:

Please select titles of those you anticipate attending this event.
(Check all that apply)

CEO, President, Administrator (Senior Management)
COO, Exec. VP, Business Manager, VP (Operations Management)
CFO, Director of Finance, Chief Accountants (Financial Management)
CIO, Info. Systems Manager, VP of MIS (Information Management)
CPO, VP/Director of Materials Management (Materials Management)
Risk Manager, Compliance Officer, Dir of Managed Care, Dir of Patient Services (Case Management)
Dir of Planning & Development, VP/Dir of Marketing, Public Relations, HR (General Admin)
VP of Radiology, Dir of Radiology, Radiology Administrator (Medical Imaging)

Others (please list titles):

Industry Focus:

Please select the type of organization attendees will come from.
(Check all that apply)

Hospitals
Payers
Medical Groups/Clinics
Nursing Homes

Others (please list):

Please list any other media sponsors for this event (i.e. print or online publications).

Please list any other industry sponsors for this event (i.e. hospital, association or vendor).

Please list any prominent keynote or session healthcare speakers for this event.

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