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2026 Florida Maternal Health Convening
2026 Florida Maternal Health Convening – Attendee Registration
2026 Florida Maternal Health Convening – Sponsor Registration
2026 Health Center Emergency Management Summit
2026 Emergency Management Summit – Attendees
2026 Emergency Management Summit – Sponsors
Call for Abstracts
2026 FACHC Annual Conference
FACHC Events Code of Conduct
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2026 Florida Maternal Health Convening – Sponsor Registration
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2026 Florida Maternal Health Convening…
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3
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About your Organization
Organization Name
(Required)
Contact Person
(Required)
First
Last
Title
(Required)
Phone
(Required)
Email
(Required)
Company Logo
Accepted file types: jpg, pdf, png, Max. file size: 32 MB.
Please upload the logo that should be used in media outreach and event publications.
Select your Sponsorship
(Required)
Select your Sponsorship
Breakfast Sponsor
Lunch Sponsor
AM Coffee Break Sponsor
PM Coffee Break Sponsor
AM & PM Break Sponsor
Attendee Bag Sponsor
Name Badge & Lanyard Sponsor
Wi-Fi Sponsor
Total
Section Break
Please complete the information below for the Person(s) who will be attending.
#1 Attendee Name
(Required)
First
Last
#1 Attendee Title
(Required)
#1 Attendee Email
(Required)
#1 Attendee Phone
(Required)
#1 Attendee Dietary Restrictions:
(Required)
#2 Attendee Name
(Required)
First
Last
#2 Attendee Title
(Required)
#2 Attendee Email
(Required)
#2 Attendee Phone
(Required)
#2 Attendee Dietary Restrictions:
(Required)
Billing Information:
The name & address listed below must match the Credit Card used.
Total
Coupon
Credit Card
(Required)
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Security Code
Cardholder Name
Billing Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
FACHC Events Code of Conduct Acknowledgement:
(Required)
By submitting this registration form, I confirm that I have read and agree to the FACHC Events Code of Conduct, which is linked below.
FACHC Events Code of Conduct
REFUND POLICY ACKNOWLEDGEMENT:
(Required)
By submitting this registration form, I acknowledge that all Sponsorships are considered Final and no refunds will be issued.
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