Media Partnership Proposal Form

Media Partnership Proposal Form

Want to enter into a media trade with Modern Healthcare?

Please fill out this form to see if you qualify.

Organization*

Contact Name*

Title*

Phone*

Email*

Please list your goals in partnering with Modern Healthcare.

Event Name*

Event Date*

Event Location

Is this your event?

Select

Event Website Link

Upload your event prospectus or documention here:

Drag and drop files here or

Number of anticipated attendees

Audience Demographics (titles & industry)

Event Content/Theme

Please list any prominent speakers

Please list any other media sponsors

Please list any other industry sponsors

Send me a copy of my responses