Sponsorship Application

Applicant Information
Name*

PrefixFirst NameLast Name
Title*
Phone*
Please enter a valid phone number.
Email*
example@example.com
Applicant Organization*
Organization Information

Please provide the Organization Name and address to be paid, if approved:
Organization Name*
Street Address*
City*
State*
Zip Code*
Federal Tax ID*
Website URL*
W-9
Checks must be made payable to the organization, as listed on the W-9. Please attach a W-9 for the education conference provider. Please use the most recent IRS W-9 Form published as shown in the picture below. Click here to download the form from the IRS website.
Payment Contact
Name*

First NameLast Name
Title*
Phone*
Please enter a valid phone number.
Email*
example@example.com
Payment Address*
City*
State*
Zip Code*
Conference Information
Conference Title*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Conference City*
Conference State*
Venue (hotel name, conference center, etc.)*
Cost to Exhibit*
Expected number of attendees this year*
Number of attendees last year*
Is this program accredited?*

YesNo
Name of accreditation organization*
Number of Credit Hours*
Name of the agency or institution.*
Has Tampa Genera Hospital exhibited at this event in the past?*

YesNo
Please provide the Tampa General Hospital Representative contact name that has expressed an interest in exhibiting at this event, if any.
Name*

First NameLast Name
ADDITIONAL DOCUMENTS
Please attach the following documents in PDF format.

Letter of request

Must include, among other things:
- Exhibitor Prospectus (Description of Exhibit Space).
- Description of expected conference attendees (focus group).
- Description of value proposition for TGH participation (3-5 sentences).
File *

Cancelof
Program Agenda - Conference Brochure
File*

Cancelof
Levels of Sponsorship (if applicable)

Attach levels of sponsorship, if applicable, or any additional documents to describe the program.
File Upload

Cancelof
Budget Summary
- Indicate what is the expected return on TGH’s investment (ROI)?
- In what way(s) will you demonstrate this ROI?
File Upload*

Cancelof
Note: Unfortunately, due to limited funding, not every quality program will receive Tampa General Hospital’s support.
Certification
Certification*

By submitting this form, you indicate that you are acting under the authorization of the entity requesting Tampa General Hospital funds and that all statements contained in this application are accurate and complete to the best of your knowledge.
Should be Empty:

Applicant Information

Organization Information

Conference Information

ADDITIONAL DOCUMENTS

Certification