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30th Delaware Healthcare Forum
October 29, 2026
Bally's Dover Casino Resort
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Member Registration ( $75 )
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Level 1 Sponsor - Booth ( $7500 )
level 2 Sponsor - Platinum ( $5000 )
Level 3 Sponsor - Gold ( $2000 )
Level 4 Sponsor - Silver ( $1000 )
Level 5 Sponsor - Bronze ( $500 )
Level 6 Sponsor - Advertisement in Program Booklet
Level 7 Sponsor - Banners ( $250 )
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