2026 Paving the Way to Health Care Access Sponsorship Form We would like to sponsor the 2026 Paving the Way to Health Care Access Conference at the following level: Please check one * Platinum Sponsor ($7,500) Gold Sponsor ($3,000) Silver Sponsor ($1,500) Bronze Sponsor ($750) Sparkle Sponsor ($350) Organization * Name of Contact * Email * Address * Address Address Address City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zipcode Zipcode Phone * Organization website * Please choose method of payment * Credit Card (A payment link will be emailed to the above email address) Check (make payable to UMass Chan Medical School) Mail check to: UMass Chan Medical School Bursar’s Office S1-802 55 Lake Avenue North, Worcester, MA 01655 RE: PTW Conference Logo Upload Drop your logo here or click anywhere in this area to upload – jpg, jpeg, or png format Maximum file size: 10MB Submit If you are human, leave this field blank.
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