"*" indicates required fieldsLinkedInThis field is for validation purposes and should be left unchanged.Organization InformationOrganization Name*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website*Please upload your organization logo.*Please submit a high resolution image (minimum 300dpi). Accepted file types: .jpg or .png.Max. file size: 24 MB.Contact InformationPrimary Contact* First Name Last Name Email* Enter Email Confirm Email Phone Number*Sponsor & Exhibitor PackagesWhich type of sponsorship package would you like to submit an application for?*If you are only interested in an exhibitor package, please select Event Sponsorship to view all available exhibitor packages. Annual Sponsorship Event SponsorshipPlease select your level of participation. Refer to prospectus for included benefits.* Advocate ($35,000) Partner ($30,000) Supporter ($22,500)Your selected package includes Platinum Sponsorship of the Health Care Symposium and your choice of 2 from the following.*Select exactly 2 choices. Gold Sponsor of the Health IT Summit Gold Sponsor of the Workforce Summit Sponsor of the Policy Café SeriesYour selected package includes Platinum Sponsorship of the Health Care Symposium and your choice of 1 from the following.*Select exactly 1 choice. Silver Sponsor of the Health IT Summit Silver Sponsor of the Workforce Summit Sponsor of the Policy Café SeriesPlease select the event(s) you would like to participate in as a sponsor/exhibitor.* Health Care Symposium Health IT Summit Workforce Summit Policy Café SeriesSelect AllPlease submit your package selection for the Health Care Symposium.* Platinum Sponsor ($20,000) Gold Sponsor ($15,000) Silver Sponsor ($10,000) Bronze Sponsor ($5,000) Exhibitor ($3,000) Non-Profit Exhibitor ($2,500)Please submit your package selection for the Health IT Summit.* Platinum Sponsor ($10,000) Gold Sponsor ($8,000) Silver Sponsor ($6,000) Bronze Sponsor ($4,000) Event Sponsor ($2,000)Please submit your package selection for the Workforce Summit.* Platinum Sponsor ($10,000) Gold Sponsor ($8,000) Silver Sponsor ($6,000) Bronze Sponsor ($4,000) Event Sponsor ($2,000)Please submit your package selection for the Policy Café Series.* Host Sponsor ($7,000) Sponsor ($4,000)This field is hidden when viewing the formExhibitor Information (Annual Sponsors)Your sponsorship package includes an exhibit space at the Health Care Symposium, Health IT Summit, and Workforce Summit. Please indicate below which exhibit space(s) you plan to use.* Exhibit space at the Health Care Symposium Exhibit space at the Health IT Summit Exhibit space at the Workforce Summit I do not plan to use any of the exhibit spaces included in my sponsorship package.Your sponsorship package includes an exhibit space at the Health Care Symposium. Do you plan to use your exhibit space?* Yes, I plan to use my exhibit space at the Health Care Symposium. No, I do not plan to use my exhibit space at the Health Care Symposium.Your sponsorship package includes an exhibit space at the Health IT Summit. Do you plan to use your exhibit space?* Yes, I plan to use my exhibit space at the Health IT Summit. No, I do not plan to use my exhibit space at the Health IT Summit.Your sponsorship package includes an exhibit space at the Workforce Summit. Do you plan to use your exhibit space?* Yes, I plan to use my exhibit space at the Workforce Summit. No, I do not plan to use my exhibit space at the Workforce Summit.Please fill in the details below for the primary contact at your organization responsible for coordinating all logistics related to exhibiting.* First Name Last Name Email Please enter the amount of additional exhibitor registrations you would like to purchase for the Health Care Symposium. Leave blank if none. QuantityPlease note that each exhibit space includes 2 complimentary exhibitor registrations. This field is for exhibitor registrations you would like to purchase in addition to the complimentary registrations included with your exhibit space(s). Price: $350.00 Quantity This field is hidden when viewing the formExhibitor Information (Symposium)Your selection includes an exhibit space at the Health Care Symposium. Do you plan to use the exhibit space included in your selected package?* Yes, I plan to use the exhibit space at the Health Care Symposium. No, I do not plan to use the exhibit space included in my package.Please fill in the details below for the primary contact at your organization responsible for coordinating all logistics related to exhibiting.* First Name Last Name Email Please enter the amount of additional exhibitor registrations you would like to purchase. Leave blank if none. QuantityPlease note that each exhibit space includes 2 complimentary exhibitor registrations. This field is for exhibitor registrations you would like to purchase in addition to the complimentary registrations included with your exhibit space(s). Price: $350.00 Quantity This field is hidden when viewing the formExhibitor Information (Health IT)Your selection includes an exhibit space at the Health IT Summit. Do you plan to use the exhibit space included in your selected package?* Yes, I plan to use the exhibit space at the Health IT Summit. No, I do not plan to use the exhibit space included in my package.Please fill in the details below for the primary contact at your organization responsible for coordinating all logistics related to exhibiting.* First Name Last Name Email Please enter the amount of additional registrations you would like to purchase for the Health IT Summit. Leave blank if none. QuantityThis field is for attendee registrations you would like to purchase in addition to the complimentary registrations included in your sponsorship package. Price: $100.00 Quantity This field is hidden when viewing the formExhibitor Information (Workforce)Your selection includes an exhibit space at the Workforce Summit. Do you plan to use the exhibit space included in your selected package?* Yes, I plan to use the exhibit space at the Workforce Summit. No, I do not plan to use the exhibit space included in my package.Please fill in the details below for the primary contact at your organization responsible for coordinating all logistics related to exhibiting.* First Name Last Name Email Please enter the amount of additional registrations you would like to purchase for the Workforce Summit. Leave blank if none. QuantityThis field is for attendee registrations you would like to purchase in addition to the complimentary registrations included in your sponsorship package. Price: $100.00 Quantity Payment InformationTotal Send invoice to:Address* Same as previous Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Attn:* First Name Last Name Email* Enter Email Confirm Email TERMS & CONDITIONS* 1. EXHIBIT SPACE – Each exhibit space is standard 8’ x 8’ with table-top setup. Each exhibitor will be provided with a 6’ table and two (2) chairs. 2. RATES AND ASSIGNMENTS – Assignments will be made on a first come, first served basis. Each space includes two exhibitor personnel. 3. PAYMENT – Sponsorship status and/or exhibiting is not final until payment is received; all fees are non-refundable after March 1, 2026; all contributions are 100% tax deductible. Payment methods include check and ACH/EFT. Access denied with any pending past due balances. 4. EXHIBIT LOCATION AND FLOOR PLAN – Exhibits will be located as indicated on the official floor plan. Event management reserves the right to make modifications as necessary. 5. FAILURE TO OCCUPY – Space not occupied by the close of installation (unless previous written arrangements were made) will be forfeited by the Exhibitor. CCALAC may resell, reassign, or use the space. 6. CANCELLATION OF EXHIBIT CONTRACT – CCALAC must be notified of exhibitor cancellation in writing to receive a refund by March 1, 2026. A cancellation fee of $250 per exhibit space will be charged to an exhibitor who cancels their contract. No refunds will be made after this date. 7. PASSES – Each exhibit space will be provided with a total of two (2) exhibitor registrations. All exhibitor personnel must register and wear their badges for admission to the exhibit hall, special meals, and other CCALAC-hosted social events. 8. CONFLICTING MEETINGS AND SOCIAL EVENTS – In the interest of the entire event, Exhibitor agrees not to extend invitations, call meetings, or schedule social events involving attendees, or otherwise encourage the absence of members, other exhibitors, or invited guests at any time during the dates of the event, without permission from the event organizers. 9. INSTALLATION AND DISMANTLING OF EXHIBITS – Setting up, tearing down, and removal of exhibits are the responsibility of the Exhibitor. Should the Exhibitor fail to remove the exhibit, removal will be arranged by event management at the Exhibitor’s expense plus a $100 fee. 10. LIABILITY – Exhibitor assumes responsibility and agrees to indemnify and defend CCALAC, the event venue, and their respective employees and agents against any claims or expenses arising out of the use of the exhibition premises. Neither CCALAC nor the event venue maintains insurance covering the Exhibitor’s property and it is the sole responsibility of the Exhibitor to obtain such insurance coverage if desired. By checking this box, I accept and agree to the Terms and Conditions.CODE OF CONDUCT AGREEMENT*PRINCIPLES AND EXPECTATIONS OF CCALAC EVENT PARTICIPATION The right to participate is essential to create open dialogue between all attendees. The Community Clinic Association of Los Angeles County (CCALAC) acknowledges the freedom of expression of speakers, participants, sponsors, and vendors. All participants attending a CCALAC event are subject to the laws applicable in the United States and the State of California, where the event is being held. By attending the Annual Southern California Health Care Symposium, Annual Health IT Summit, Annual Workforce Summit, and/or Policy Café Series, participants agree to adhere to these Principles and Values of Event Participation. GENERAL PRINCIPLES All attendees shall conduct themselves in a professional, courteous and respectful manner, refraining from language and actions that might bring discredit upon themselves, their organization, the event(s), or CCALAC. To build a safe space, CCALAC urges attendees to listen actively, promote respect, give everyone an opportunity to speak, encourage open dialogue, and embrace vulnerability. ADMISSION CCALAC reserves the right to refuse admission to the event(s) if an individual or group has previously advocated or supported violent actions or destructive behavior in any way, or if those individuals have previously violated any rule of conduct or applicable law at any prior CCALAC event. Additionally, during the event(s), CCALAC can revoke event registration, and associated materials, and thereby, deny access to participants who do not adhere to this Code of Conduct. VIDEO AND AUDIO RECORDING Attendees are strictly prohibited from videotaping or audio recording any part of the event(s) unless written permission has been granted by CCALAC. Failure to comply with this rule is grounds for immediate ejection from the event(s) and confiscation of video and/or audio materials. This rule applies to all sessions and events throughout the duration of the Annual Southern California Health Care Symposium, Annual Health IT Summit, Annual Workforce Summit, and/or Policy Café Series. PROCEDURES INVOLVING DISRUPTIONS AT THE EVENT(S) – APPLICATION OF THE LAW Event participants are subject to the laws applicable in the United States. Disruptive behavior in any form (e.g., verbal or physical) including harassment and bullying will not be tolerated and will be dealt with in accordance with the laws of the U.S. and the State of California, where the event is being held. WITHDRAWAL OF ADMISSION In the event of any disruptions, including harassing or persistently taunting an attendee, speaker, vendor or sponsor, or any other action that does not respect these Principles, CCALAC may withdraw a participant’s admission and suspend or cancel the participant’s access to the event. Violation of the rules is also grounds for ineligibility at future CCALAC events. PUBLIC STATEMENT In the event that freedom of expression is abused, property is destroyed, stolen or physical force is used or threatened by a participant, CCALAC may issue a statement concerning the action that reflect the framework of the Principles and Values of Event Participation. Attendees expelled from any CCALAC event for violations of this Code of Conduct will not be afforded a refund or credit for event attendance fees. SECURITY INFORMATION Event badges will be required for admittance to all events for security reasons. Badges should be worn and visible at all times. Lost badges should be reported to CCALAC staff immediately. The following badge policies apply throughout the entirety of the event: CCALAC is the sole proprietor of event badges and lanyards. BADGES ARE NONTRANSFERABLE Misuse of badges, lanyards, false certification of individuals as paid attendees, efforts to assist unauthorized persons to gain access to any event, or any inappropriate conduct will be just cause for reclaiming badges of any individuals involved. By checking this box, I accept and agree to the principles outlined in the Code of Conduct Agreement.MEDIA DISCLAIMER*By attending the Annual Southern California Health Care Symposium, Annual Health IT Summit, Annual Workforce Summit, and/or Policy Café Series as a sponsor and/or exhibitor, you consent to be photographed, filmed and/or otherwise recorded. Your entry constitutes your consent to such photography, filming and/or recording and to any use, in any and all media throughout the universe in perpetuity, of your appearance, voice and name for any purpose whatsoever in CCALAC promotions and materials. You waive the right to payment for CCALAC’s use of any of the material described above and you also waive any right to inspect or approve finished media, documents or other items incorporating the material described above. Please contact tburks@ccalac.org if you have questions or concerns, or wish to opt out no later than March 27, 2026. By checking this box, I acknowledge that photos and video may be taken during the event(s) selected in my sponsorship/exhibitor package and may be used in CCALAC’s communications, marketing and materials.IMPORTANT INFORMATION FOR EXHIBITORS*Please note that each exhibit space is standard 8’ x 8’ with table-top setup. Please do not bring any materials that are larger than 8' x 8'. If you plan to bring any bulky materials for your exhibit, please inform CCALAC as soon as you are able so that exhibit space assignments can be planned for accordingly. CCALAC reserves the right to make modifications to your exhibit location and floor plan as necessary. By checking this box, I acknowledge and agree to the information outlined above.
