Become an Affinity Partner Name(Required) First MI Last Company NameCompany Address(Required) Street Address City State / Province / Region ZIP / Postal Code Office Telephone(Required)CellFaxEmail Address(Required) WebsiteDescription of ServicesAttach Company LogoMax. file size: 50 MB.Affinity Partner and Hartford County Medical Association (HCMA) agree that no party will finalize, produce or distribute promotional or marketing material referring to the other or its services and/or products without prior written approval of the other. By signing this form below, Affinity Partner gives HCMA permission to display its logo and website information on HCMA’s website and distribute promotional or marketing material with Affinity Partner's company name, description of services, logo, and website. Affinity Partner is responsible for notifying HCMA in the event its company name, logo or website information changes. This shall not be construed to create any joint venture, partnership or agency relationship between Affinity Partner and HCMA, nor shall it be an endorsement of Affinity Partner.Affinity Partner of the Association(Required) Current Affinity Partners Affinity Partner Benefits Pay Via Affinipay
