White Paper/Case Study Sponsor Registration White Paper / Case Study Sponsorship Registration View a list of included benefits with your registration! Company Details Company Name * Name of Contact * Phone * Email * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Does your company or organization require provisions or restrictions for sponsorship monies? * Yes No Please Describe: * Event Details Affiliate and Supporting Members of OAHP are entitled to your choice of one of the following, included with annual membership: 2 White Papers; or 2 Case Studies; or 1 White Paper and 1 Case Study; or 1 Sixty (60) Minute Webinar Is your company an OAHP Affiliate or Supporting member? * Yes No Which Member? * AbbVie Access 2 Care Ameridial, Inc. Apellis Pharmaceuticals, Inc. AstraZeneca AudioNet America Avesis (The Guardian Life Insurance Company of America) Bayer HealthCare Biogen CAQH CareAdvisors Delta Dental DentaQuest Genentech Gilead Sciences Health Management Associates (HMA) Jefferson Health Plan Joint Academy, Inc. Little Hercules Foundation Magellan Health Medline Industries Merck Navitus Health Solutions New Century Health Novartis Services Novo Nordisk Orexo Pharmaceuticals OSU Health Plan Provide A Ride Sarepta Therapeutics Sellers Dorsey & Associates, LLC Squire Patton Boggs Sun Pharma Thrive Behavioral Health Center UCB Pharma VaxCare LLC Verrica Pharmaceuticals Versant Health Vertex Pharmaceuticals For which are you registering? * White Paper - included with membership Additional White Paper - $1,000 Case Study- included with membership Additional Case Study - $1,000 OtherOther For which are you registering? (Non-member) * White Paper- $2,000 Case Study- $2,000 Title / Summary of Presentation * Please submit an electronic sponsor logo and title of your presentation along with a 50 word or less description of your organization. Company Profile Description (50 words or less) * Company Logo * Drop a file here or click to upload Choose File Maximum upload size: 100MB Payment and Terms Total to be processed: Payment Method * Check: Mail to OAHP, 20 E. Broad Street, Suite 701, Columbus, Ohio 43215 PayPal / Credit Card Payment is requested within 45 days of registration date. All cancellations for general or non-Convention OAHP Sponsorship opportunities MUST be received in writing by OAHP 45 days prior to the scheduled event to receive a refund less an amount equal to 25% of the total sponsorship amount. After the 45 day advance event cancellation deadline, then the full sponsorship payment is still required even if sponsor is unable to participate or OAHP is able to resell the the sponsorship opportunity. NO cancellations will be accepted or refunds issued for no-shows. By submitting this electronic form you provide OAHP the authority to charge the credit card provided and agree to all terms. If you are human, leave this field blank. Submit
