2026 Emergency Management Summit – Sponsor Registration – Florida Association of Community Health Centers

Step 1 of 4

Organization & Contact Details

Organization Name(Required)

Contact Person(Required)

First Last

Title(Required)

Email(Required)

Phone(Required)

How would you like to pay?(Required)

Pay by Check

Pay by Credit Card

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address City State ZIP Code

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

Sponsorship Sales Policy Acknowledgement:(Required)

By submitting this registration form, I acknowledge and agree that all Sponsorship Sales are considered final and non-refundable.

Additional Attendee Refund Policy Acknowledgement:(Required)

By submitting this registration form, I acknowledge and agree that all Attendee Cancellation & Refund Requests must be made in writing on or before April 1, 2026. All eligible refund requests will be subject to a $50 administrative fee. There will be no refunds issued after April 1, 2026.

Please send all Attendee Cancellation & Refund Requests to FACHC Events & Sponsorship Manager, Nicole Rechner at nrechner@fachc.org.

Organization & Contact Details

Sponsorship Details

Attendee Information