AIM Provider ToolKit Website

2016 Sponsorship Form


Cost of 2016 Sponsorship: $2,500

Please remit by January 30, 2016

AIM’s tax ID number will be sent in a confirmation e-mail to your organization.
Please make check payable to: Please mail check to:
Alliance for Immunization in Michigan Leigh Anne Jewison
Michigan Health & Hospital Association
110 W. Michigan Avenue
Suite 1200
Lansing, MI 48933

If an organization other than the one listed below will be submitting the check, please ask that organization to write your name on the check, so that we can identify who the payment is intended to come from.

Sponsor Information


Organization Name
(As you wish it to appear on materials)

Website Address
Contact Name
Address
City
State
ZIP
Phone
Email


About Your Organization


Please write a short paragraph or blurb about your organization to be included on the Featured Sponsor Webpage which will launch in 2016. Be sure to include the mission of your organization, examples of how your organization is working to improve immunization rates in Michigan, and any other relevant information you would like to share. (Word Limit: 500 words)

Desired Feature Month

(Check all that apply)

If there is a desired month that you would like your organization to be featured, please let us know and we will do our best to accommodate you. Please check the desired month(s) below; if you have no preference, simply leave this question blank.

January
Februrary
March
April
May
June
July
August
September
October
November
December


Your Image


Please upload a picture of your choice to be included on the Featured Sponsor Webpage.
Select image to upload (must be under 5 MB):

Thank you for sponsoring the AIM Toolkit Website and for helping AIM to increase vaccination rates in Michigan. Read about our current sponsors here.