Reach Nebraska s Nursing Facilities, Assisted Living Communities, Hospices, and LPNs. join sponsor exhibit advertise

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1 Reach Nebraska s Nursing Facilities, Assisted Living Communities, Hospices, and LPNs 2015 join sponsor exhibit advertise

2 The Nebraska Health Care Association is the parent to a family of entities: the Nebraska Nursing Facility Association, Nebraska Assisted Living Association, Nebraska Health Care Learning Center, Nebraska Hospice and Palliative Care Association, Licensed Practical Nurse Association of Nebraska, and Nebraska Health Care Foundation. NHCA gives you four simple ways to market your organization s products and/or services to Nebraska s nursing facilities, assisted living communities, hospices, and LPNs: Join, Sponsor, Exhibit, Advertise. join. sponsor. exhibit. advertise. The Licensed Practical Nurse Association of Nebraska is a professional organization that supports, promotes and represents all aspects of practical nursing in Nebraska. Contact us for opportunities to market your business to LPNs and practical nursing students in Licensed Practical Nurse Association of Nebraska 1200 Libra Dr Ste 100, Lincoln NE phone fax lpn

3 sponsor. exhibit. advertise. The Nebraska Nursing Facility Association and Nebraska Assisted Living Association serve more than 400 long-term care facilities throughout the state. NNFA and NALA are privileged to also represent more than 100 businesses through a Business Associate Membership each year. Annual dues of $375 provide many benefi ts including: Timely information on issues pertaining to the Nebraska nursing facility and assisted living community profession Discounts and advance opportunities to secure trade show space Member prices for education, advertising, products, services, and sponsorships Listing in convention books and on the NNFA/NALA website Access to members-only information on nehca.org Opportunity for participation on committees and Board of Directors (if elected) to shape NNFA/ NALA activities Regular updates of national and Nebraska long-term care news Technical assistance from NNFA/NALA staff join. exhibit. advertise. TIER SPONSORSHIPS Tier Sponsorship allows your business to experience recognition throughout the year with a one-time sponsorship fee. Tier Sponsor Levels Diamond (limited availability)... $15,000 Platinum... $ 7,500 Gold... $ 5,000 Bronze... $ 2,500 It s important to note that Tier Sponsorship includes a Business Associate Membership, so it s a wise fi nancial decision to become a Tier Sponsor. Benefi ts also include recognition with a hyperlinked logo on NNFA/NALA s website, recognition in Keeping You Connected newsletter, recognition at two conventions, the opportunity to speak to attendees at sponsored events, recognition as a Tier Sponsor on sponsored event and convention PowerPoints, and access to the attendee mailing list of sponsored event(s). In addition to the above benefi ts, the following are provided to 2015 Tier Sponsors:

4 $15,000 per year (a $24,243 value) Limited availability. $7,500 per year (a $12,713 value) Spring Convention One premier booth or two standard booths Divider-page ad in convention book Sponsorship of either 1) Thursday breakfast buffet and one education session or 2) Closing speaker and one education session Fall Convention One standard booth (sponsor may choose to pay an additional amount to upgrade if space is available) Divider-page ad in convention book Sponsorship of either 1) Keynote speaker or 2) Two education sessions Education Sponsorship of two freestanding NNFA or NALA multiday or single-day workshops Newsletter Opportunity to submit an approved article and one quarter-page ad in one issue of NHCA s Keeping You Connected newsletter Opportunity to submit a brief approved article in two issues of NNFA/NALA s electronic newsletter, Nebraska Now $5,000 per year (an $8,593 value) Spring Convention One standard booth (sponsor may choose to pay an additional amount to upgrade if space is available) Full-page ad in convention book Sponsorship of one lunch, breakfast, brunch, or education session Fall Convention One standard booth (sponsor may choose to pay an additional amount to upgrade if space is available) Full-page ad in convention book Sponsorship of a lunch or an education session Education Sponsorship of one day of NNFA Executive Nurse Leadership Training or one day of NALA Assisted Living Administrator Training Sponsorship of one freestanding NNFA or NALA multiday or single-day workshop $2,500 per year (a $5,973 value) Spring Convention Half-price standard booth fee (sponsor may choose to pay an additional amount to upgrade) Half-page ad in convention book Sponsorship of a break or an education session Fall Convention Half-price standard booth fee (sponsor may choose to pay an additional amount to upgrade) Half-page ad in convention book Sponsorship of a break or an education session

5 The Nebraska Health Care building at 1200 Libra Drive in Lincoln offers state-of-the-art classrooms, a training room, student/member union, and skills lab. More than 2,000 long-term care professionals receive education in the space each year. Room Sponsorships Room sponsorships are secured for eight years. Sponsors receive recognition on registration fl yers, permanent (eight-year) signage, opportunity to provide co-branded and pre-approved notepads for length of the agreement to individuals attending education in respective classroom, and recognition on event postings at nehca.org. SOLD! West Classroom SOLD! South Classroom SOLD! North Classroom Training Room Union Skills Lab $30,000 for eight years $30,000 for eight years $24,000 for eight years $24,000 for eight years $24,000 for eight years $24,000 for eight years Website Sponsorships The website of NNFA, NALA, Licensed Practical Nurse Association of Nebraska, Nebraska Health Care Foundation, and Nebraska Health Care Learning Center is the associations main source of information and the site address is included in all materials, publicity and specialty items. Website sponsors logos and links to their websites appear on the sponsored page. Website sponsorships are secured for a minimum of one year. Main Landing Pages Member $750 Non-Member $1,000 Subpages Member $500 Non-Member $750 Additional Pages Member $250 Non-Member $500 Basic Nursing Assistant and Medication Aide Training Sponsorship The Nebraska Health Care Learning Center is a private post-secondary career school managed by the Nebraska Health Care Association. The Learning Center offers accelerated Basic Nursing Assistant and Medication Aide training throughout the year. NHCLC Basic Nursing Assistant and/or Medication Aide Lunch Sponsorship $250 ($500 Non-Member). Single sponsor per day. Fee provides lunch for students and the opportunity to have a table-top display in the training room during 30-minute lunch break. Class size ranges from three to 20 students. Benefi ts are subject to change depending on continuing education requirements. All sponsorship opportunities are sold on a fi rst come basis, and monies will be received at the Nebraska Health Care Association offi ce before sponsors are promoted. Tier Sponsors benefi ts hold priority over other sponsors benefi ts.

6 Convention Sponsorships Spring Convention Approximately 750 nursing facility and assisted living professionals will attend this four-day event at the Younes Conference Center in Kearney, Neb., April 20-23, All convention sponsors receive their company name in the convention registration fl yer, in the convention book, and on the designated session s signage. Notepads $2,000 ($2,500 Non-Member). Single sponsor. Your logo will be printed on notepads provided to convention attendees. Lanyards $1,500 ($2,000 Non-Member). Single sponsor. See your company s name on attendees name badge lanyards. Name Badges $1,000 ($1,500 Non-Member). Single sponsor. Your company s logo will be printed on attendees name badges. Information Packet $1,000 ($1,500 Non-Member). Single sponsor. Your company s logo will be printed on the cover of the on-site Information Packet distributed to convention attendees. Wi-Fi $750 ($1,250 Non-Member). Single sponsor. Your company s logo will be printed on the Wi-Fi information page distributed to convention attendees. Breakfast/Lunch $500 Per Meal ($1,000 Per Meal Non-Member). Multiple sponsors. Receive the opportunity to provide pre-printed marketing materials at each table. Education Sessions $500 Per Session ($1,000 Per Session Non-Member). Multiple sponsors. A variety of sessions are available for sponsorship. Attempts are made to match sponsors with a topic that best targets their product or service. Receive the opportunity to include pre-printed marketing materials, the opportunity to have a tabletop display in the education session room, and verbal recognition at the beginning of the session. Brochure Distribution $400 ($800 Non-Member). Provides an avenue for brochure distribution for vendors who are unable to exhibit at the convention trade show. Nonexclusive. Refreshment Breaks $250 Per Break ($750 Per Break Non-Member). Multiple sponsors. Receive the opportunity to provide pre-printed marketing materials in break area. Fall Convention Approximately 900 nursing facility and assisted living professionals attend this four-day event at the La Vista Conference Center in La Vista, Neb., Sept. 28-Oct. 1, All convention sponsors receive their company name in the convention registration fl yer, in the convention book, and on the designated session s signage. Notepads $2,250 ($2,750 Non-Member). Single sponsor. Your logo will be printed on notepads provided to convention attendees. Opening Session Keynote Speaker $1,500 ($2,000 Non-Member). Single sponsor. With approximately 500 attendees, sponsoring this session will put the sponsor s company name in front of attendees before the trade show opens. Receive the opportunity to include pre-printed marketing materials, the opportunity to have a table-top display in the education session room, and verbal recognition at the beginning of the session. Lanyards $1,750 ($2,250 Non-Member). Single sponsor. See your company s name on attendees name badge lanyards. Name Badges $1,250 ($1,750 Non-Member). Single sponsor. Your company s logo will be printed on attendees name badges. Information Packet $1,250 ($1,750 Non-Member). Single sponsor. Your company s logo will be printed on the cover of the on-site Information Packet distributed to convention attendees. Wi-Fi $1,000 ($1,500 Non-Member). Single sponsor. Your company s logo will be printed on the Wi-Fi information page distributed to convention attendees. Breakfast/Lunch $750 Per Meal ($1,250 Per Meal Non- Member). Multiple sponsors. Receive the opportunity to provide pre-printed marketing materials at each table. Education Sessions $750 Per Session ($1,250 Per Session Non-Member). Multiple sponsors. A variety of sessions are available for sponsorship. Attempts are made to match sponsors with a topic that best targets their product or service. Receive the opportunity to include pre-printed marketing materials, the opportunity to have a table-top display in the education session room, and verbal recognition at the beginning of the session. Brochure Distribution $650 ($1,050 Non-Member). Provides an avenue for brochure distribution for vendors who are unable to exhibit at the convention trade show. Nonexclusive. Refreshment Breaks $500 Per Break ($1,000 Per Break Non-Member). Multiple sponsors. Receive the opportunity to provide pre-printed marketing materials in break area.

7 A La Carte Education Sponsorships Freestanding educational events are provided to nursing facility and assisted living professionals at various sites across the state and throughout the year. Some are more than one day in length and each day may have a different sponsor. Sponsors receive recognition on the event s registration fl yer mailed to more than 1,200 members and non-members, company name on event signage, the opportunity to provide pre-printed marketing materials, the opportunity to have a table-top display in the workshop room, and verbal recognition at the beginning of the workshop with the opportunity to speak to attendees. EDUCATION TOPIC DATE(S) LOCATION MEMBER NON-MEMBER SOLD! District Education Jan 21-22, 27-28, 6 sites $250/site or $750/site or Feb 4-5 $1,000 for all $1,500 for all MDS 3.0 Intensive Training Feb Lincoln $500/day $1,000/day Administrator Preceptor Training Feb 19 Lincoln $500 $1,000 Restorative Nurse/Restorative Aide Training March 3-4 Lincoln $250/day $750/day SOLD! Annual Legislative Day March 5 Lincoln $1,000 $1,500 Human Resources Workshop March 6 Lincoln $500 $1,000 ICD-10 Training April 9 Lincoln $500 $1,000 Advanced Activities Training April 20 Kearney $500 $1,000 Assisted Living Administrator Training May 19-21, June Lincoln $500/day $750/day Social Service Designee Training June 2-4, Lincoln $250/day $750/day Nurse Leadership Training June 9-11 Lincoln $250/day $750/day Executive Nurse Leadership Training June 9-11, July Lincoln $250/day $750/day SOLD! District Education July 22-23, Aug 5-6, 6 sites $250/site or $750/site or Aug $1,000 for all $1,500 for all ICD-10 Training July 28 Lincoln $500 $1,000 Alzheimer s/dementia Certifi cation Training Aug Lincoln $500/day $1,000/day Quality Issues Symposium Aug Lincoln $250/day $750/day Restorative Nurse/Restorative Aide Training Oct Kearney $250/day $750/day Medicare Training Oct Lincoln $500/day $1,000/day Quality Awards Training Nov 4 Lincoln $500 $1,000 Assisted Living Administrator Training Nov 10-12, Dec 2-3 Lincoln $250/day $750/day AANAC MDS RAC-CT Certifi cation Training Nov Lincoln $500/day $1,000/day Dates, locations and titles are subject to change. Tier Sponsors benefi ts including selection of education hold priority over other sponsors benefi ts. Some benefi ts may vary depending on an event s format and be limited due to accreditation guidelines.

8 join. sponsor. advertise. The NNFA/NALA Spring Convention Trade Show will be April 21, 2015, at the Younes Conference Center in Kearney, Neb. Booth fees range from $645 to $1,075 for NNFA/NALA members and $1,040 to $1,460 for nonmembers. The NNFA/NALA Fall Convention Trade Show is scheduled for Sept. 29, 2015, at the La Vista Conference Center in La Vista, Neb. Booth fees range from $690 to $1,350 for NNFA/NALA members and $1,080 to $1,740 for nonmembers. Exhibitor registration information for the NNFA/NALA Spring and Fall Conventions is distributed via in January and May, respectively. Exhibit registrations cannot be accepted until that time. Space fi lls quickly! 2015 Tier Sponsors have fi rst rights on exhibit space, followed by Business Associate Members, then non-members. The Nebraska Health Care Foundation is a 501(c)(3) tax-exempt organization established by the Nebraska Health Care Association in NHCF distributes more than 30 annual scholarships to individuals interested in seeking long-term care education. Scholarship funds are collected through direct donations and events held throughout the year. Help ensure there are an adequate number of trained professionals to care for residents of the state s nursing facilities and assisted living communities by contributing to the Foundation. Donate an item or package to the NHCF Gifts Across Nebraska Benefi t Silent Auction April 21-22, 2015 Younes Conference Center, Kearney, Nebraska Serve as a sponsor or host a foursome at the NHCF Benefi t Golf Tournament September 28, 2015 Oak Hills Country Club, Omaha, Nebraska For additional information or questions contact Kathryn Nohl, Membership and Marketing Manager, at foundation

9 join. sponsor. exhibit. Newsletter Ads Keeping You Connected Twice per year the Nebraska Health Care Association publishes a high-quality, magazine-style newsletter which is distributed to 1,200 nursing facilities, assisted living communities, hospices, LPNs, vendors, and other partners. Ads must be full-color (CMYK) and submitted as PDF (.pdf), JPEG (.jpg), TIFF (.tif), or EPS (.eps) fi le type. Resolution 300 dpi or better and/or choose commercial press quality, maximum quality, or high-quality print. Bleeds accepted. Rates Member Non-Member Quarter Page... $100...$155 Half Page... $155...$250 Full Page... $250...$410 Nebraska Now NNFA/NALA sends a regular e-newsletter to more than 1,400 members and other partners. Ads are text-only, maximum 150 words. Text is due at least two days before the issue s publish date. The rate is $125 per issue for members, $200 per issue for non-members. Convention Book Ads The NNFA/NALA Spring and Fall Convention Book ad rates have been set to make it most affordable to put your name in front of convention attendees. Ads must be grayscale and submitted as PDF (.pdf), JPEG (.jpg), TIFF (.tif), or EPS (.eps) fi le type. Resolution 300 dpi or better and/or choose commercial press quality, maximum quality, or high-quality print. Spring Convention Rates Member Non-Member Back Cover... $280...$375 Inside Back Cover... $220...$300 Inside Front Cover... $220...$300 Divider Page... $175...$275 Full Page... $100...$160 Half Page... $65...$110 Quarter Page... $50...$80 Fall Convention Rates Member Non-Member Back Cover... $315...$400 Inside Back Cover... $285...$350 Inside Front Cover... $285...$350 Divider Page... $250...$350 Full Page... $125...$190 Half Page... $100...$160 Quarter Page... $75...$125

10 join. sponsor. exhibit. advertise. The Nebraska Hospice and Palliative Care Association is a 501(c)(3) organization created to improve the quality of life for all Nebraskans who have chronic conditions or are near the end of life and to support the various communities who care for them. NHPCA offers a Business Partner/Allied Health Partner Membership to organizations with goals and interests related to the hospice philosophy. Annual dues of $350 provide many benefi ts including: Association with partners who form one of the most progressive statewide end-of-life improvement organizations in the country Listing on the NHPCA website Access to members-only information on nehospice.org, Nebraska s premier source of hospice and palliative care information Participation on workgroups and Board of Directors (if elected) to shape NHPCA activities and create collaborative initiatives Regular updates of national and Nebraska hospice and palliative care news Discount and advance opportunity to secure trade show space Member prices for education, advertising, products, services, and sponsorships Special bulletins of pertinent regulatory issues Increased awareness as NHPCA regularly promotes end-of-life care and Nebraska hospices to the media Early access to research data Legislative presence and notifi cation of pertinent issues Technical assistance from NHPCA staff join. sponsor. exhibit. advertise. Conference Sponsorships: Living a Good Life at the End of Life Conference Approximately 300 professionals who care for patients and families with chronic or terminal illness, including physicians, nurses, therapists, social workers, administrators, and counselors will attend this two-day event at the Embassy Suites in Lincoln, Neb., March 17-18, All conference sponsors receive their company name in the conference registration fl yer, in the conference book, on the conference sponsor sign, on the designated session/event signage, plus the opportunity to place a promotional item in conference attendees tote bags. Awards Banquet $3,000 ($3,400 Non-Member). Single sponsor. Receive the opportunity to provide pre-printed marketing materials at banquet tables. Includes two complimentary banquet tickets. Registration Brochure & On-Site Program $2,000 ($2,400 Non-Member). Single sponsor. Your company s logo will be printed on the cover of the registration brochure and the onsite program. Includes a complimentary exhibit booth or one complimentary full conference registration. Tote Bags $1,500 ($1,900 Non-Member). Single sponsor. Your company s logo will be printed on the conference attendee tote bags. Lanyards $1,500 ($1,900 Non-Member). Single sponsor. See your company s name on attendees name badge lanyards. Evening Reception $1,200 ($1,600 Non-Member). Single sponsor. Receive recognition during the event. Keynote $1,000 ($1,400 Non-Member). Four available. Receive the opportunity to introduce the keynote speaker. Lunch $750 ($1,150 Non-Member). Two available. Receive the opportunity to provide pre-printed marketing materials at lunch tables. Cyberstation $500 ($900 Non-Member). Single sponsor. See your company s logo on the desktop of each cyberstation computer. Breaks $350 ($750 Non-Member). Four available. Receive recognition during the break. hospice

11 A La Carte Education Sponsorships Freestanding educational events are provided to hospice and palliative care professionals throughout the year. Sponsors receive recognition on the event s registration fl yer mailed to more than 100 members and non-members, company name on event signage, the opportunity to include pre-printed marketing materials, the opportunity to have a table-top display in the workshop room, and verbal recognition at the beginning of the workshop with the opportunity to speak to attendees. EDUCATION TOPIC DATE(S) LOCATION MEMBER NON-MEMBER ICD-10 Training for Hospice May 7 Lincoln $500 $900 Hospice Nurse Prep Class Aug 4, 18 Lincoln $250 $650 Website Sponsorships The website of NHPCA offers members, volunteer board and committee members, policymakers, prospective employees, the media, donors, and consumers multiple online options for communication, registration, employment opportunities, and training. The website is NHPCA s main source of information and the site address is included in all materials, publicity and specialty items. Website sponsors logos and links to their websites appear on the sponsored page. Website sponsors are secured for a minimum of one year. The sponsorship fee is $1,000 per main page for members ($1,500 for non-members) and $500 per subpage for members ($1,000 for nonmembers). join. sponsor. exhibit. advertise. The NHPCA Living a Good Life at the End of Life conference will be March 17-18, 2015, at the Embassy Suites in Lincoln, Neb. The booth fee is $475 for NHPCA members and $875 for non-members. Exhibitor registration information is distributed via in January. Exhibit registrations cannot be accepted until that time NHPCA members have fi rst rights on exhibit space. join. sponsor. exhibit. advertise. Newsletter Keeping You Connected Twice per year the Nebraska Health Care Association publishes a high-quality, magazine-style newsletter which is distributed to 1,200 nursing facilities, assisted living communities, hospices, LPNs, vendors, and other partners. Ads must be full-color (CMYK) and submitted as PDF (.pdf), JPEG (.jpg), TIFF (.tif), or EPS (.eps) fi le type. Resolution 300 dpi or better and/or choose commercial press quality, maximum quality, or high-quality print. Bleeds accepted. Rates Member Non-Member Quarter Page... $100...$155 Half Page... $155...$250 Full Page... $250...$410 Hospice News Nebraska NHPCA sends a regular e-newsletter to more than 800 members and other partners. Ads are text-only, maximum 150 words. Text is due at least two days before the issue s publish date. The rate is $50 per issue for members, $125 per issue for non-members. hospice

12 1200 LIBRA DR STE 100 LINCOLN NE PRSRT STD U.S. POSTAGE PAID LINCOLN NE PERMIT NO. 590 ADDRESS SERVICE REQUESTED NHCA wants to help you grow your business. Please contact us with questions on these opportunities. Nebraska Health Care Association 1200 Libra Dr Ste 100 Lincoln NE

13 NNFA/NALA VENDOR APPLICATION AND AGREEMENT NNFA/NALA Convention exhibit details will be distributed closer to event dates (NHPCA Vendor Application and Agreement on reverse) My business would like to reach Nebraska nursing facilities and assisted living facilities by serving as a 2015 NNFA/NALA member and/or sponsor: (select all that apply) BUSINESS ASSOCIATE MEMBERSHIP*, $375 (not refundable or pro-rated) SPONSOR Sponsorship Request: Diamond Tier Sponsor $15,000 (Includes Business Associate Membership) Platinum Tier Sponsor $7,500 (Includes Business Associate Membership) Gold Tier Sponsor $5,000 (Includes Business Associate Membership) Bronze Tier Sponsor $2,500 (Includes Business Associate Membership) Other Sponsorship(s): $ $ $ Organization Primary Contact Name (will appear on website for members) Address City/State/Zip Phone Fax Web Address Products/Services Description (will appear on website) *A company that owns or manages nursing facilities or assisted living facilities in Nebraska must purchase Facility Membership for those facilities. Please Sign Below Please accept this offi cial contract and agreement for our organization to be named as a member and/or sponsor as indicated above in I understand that Business Associate Members are encouraged to promote membership with NNFA/NALA and utilize membership benefi ts to the fullest but that any inference to my organization being a preferred supplier to facilities is prohibited unless expressly agreed upon and as defi ned by NNFA/NALA. I also understand that this application and my organization s intent and nature of business will be reviewed and approved by NNFA/NALA before benefi ts will be implemented. I understand that some sponsorship opportunities have limited availability. In return for sponsoring at the cost listed above, it is my understanding that my organization will receive the sponsorship recognition according to the entitlements of the sponsorship selected. I understand and agree that full payment is due in the NNFA/NALA offi ce before our organization will receive sponsorship recognition. Signed Title Date Contributions or gifts to the Nebraska Nursing Facility Association and/or the Nebraska Assisted Living Association are not tax deductible as charitable contributions for federal income tax purposes. Dues payments may be deductible by members as ordinary and necessary business expenses subject to restrictions imposed as a result of association lobbying activities. Contact the NNFA/NALA offi ce for the estimate of the nondeductible portion of your 2015 dues the portion which is allocable to lobbying. PAYMENT OPTIONS: Make checks payable to Nebraska Health Care Association Return completed and signed contract to: NHCA, 1200 Libra Drive, Suite 100, Lincoln, NE Phone Fax CHECK THIS BOX if you DO NOT WANT YOUR ADDRESS PUBLISHED online or in printed NNFA/NALA membership directories. PLEASE BILL (Members Only) CHECK ENCLOSED (Checks payable to NHCA) BILL MY CREDIT CARD FOR $ CREDIT CARD INFORMATION: To pay by credit card, complete the information below (please print) or call Cardholder s Name (PRINT) Credit Card Number Expiration Date CVC # Cardholder s Billing Address, City, State, Zip Cardholder s Signature Your signature will authorize this transaction. join. sponsor. exhibit. advertise.

14 NHPCA VENDOR APPLICATION AND AGREEMENT (NNFA/NALA Vendor Application and Agreement on reverse) My business would like to reach Nebraska hospice facilities by serving as a 2015 NHPCA member and/or sponsor: (select membership category and/or sponsorship choice(s)) BUSINESS PARTNER/ALLIED HEALTH PARTNER MEMBERSHIP, $350 (not refundable or pro-rated) SPONSOR Sponsorship Request: $ $ $ NHPCA Conference exhibit details will be distributed closer to event dates. Organization Primary Contact Name (will appear on website for members) Address City/State/Zip Phone Fax Web Address Products/Services Description (will appear on website) Please Sign Below Please accept this offi cial contract and agreement for our organization to be named as a member and/or sponsor as indicated above in I understand that NHPCA members are encouraged to promote membership with NHPCA and utilize membership benefi ts to the fullest but that any inference to my organization being a preferred supplier is prohibited unless expressly agreed upon and as defi ned by NHPCA. I also understand that this application and my organization s intent and nature of business will be reviewed and approved by NHPCA before benefi ts will be implemented. I understand that some sponsorship opportunities have limited availability. In return for sponsoring at the cost listed above, it is my understanding that my organization will receive the sponsorship recognition according to the entitlements of the sponsorship selected. I understand and agree that full payment is due in the NHPCA offi ce before our organization will receive sponsorship recognition. Signed Title Date PAYMENT OPTIONS: Make checks payable to Nebraska Hospice and Palliative Care Association Return completed and signed contract to: NHPCA, 1200 Libra Drive, Suite 100, Lincoln, NE Phone Fax CHECK THIS BOX if you DO NOT WANT YOUR ADDRESS PUBLISHED online or in printed NHPCA membership directories. PLEASE BILL (Members Only) CHECK ENCLOSED (Checks payable to NHPCA) BILL MY CREDIT CARD FOR $ CREDIT CARD INFORMATION: To pay by credit card, complete the information below (please print) or call Cardholder s Name (PRINT) Credit Card Number Expiration Date CVC # Cardholder s Billing Address, City, State, Zip Cardholder s Signature Your signature will authorize this transaction. join. sponsor. exhibit. advertise. hospice

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