2020 Sponsorship Action Request Form

Rollover to 2021 or Cancel/Refund?

Thank you for your support of the HFMA Region 1 2020 Conference. Unfortunately, as we have informed you, we are forced to cancel the conference due to the COVID-19 pandemic. We are asking that all committed 2020 sponsors and exhibitors complete the form below. Tell us what you would like Region 1 to do with you sponsorship; (1) roll it over to our 2021 Conference (at MGM Springfield) or (2) cancel the sponsorship and receive a full refund.


If electing to rollover your 2020 sponsorship to 2021, please skip the next section and continue with the Authorize & Submit section. If a payment is still outstanding we will contact you to make arrangements.

If requesting a refund, please complete the next section by providing the mailing address and name to whom the check should be mailed. If the original form of payment was credit card, we will first attempt to refund the credit card. All checks will be made payable to the company’s name.

Authorize & Submit
Signature is required.