2026 Florida Maternal Health Convening – Sponsor Registration – Florida Association of Community Health Centers

Step 1 of 3

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.

The name & address listed below must match the Credit Card used.

Total

Coupon

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code 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.

REFUND POLICY ACKNOWLEDGEMENT:(Required)

By submitting this registration form, I acknowledge that all Sponsorships are considered Final and no refunds will be issued.