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Date
First Name

Last Name

Title
Company
Address
City
State
Zip
Phone
Fax (optional field)
Email
Years of service in healthcare:
 
Please indicate if you are renewing an existing membership or registering as a new member:
Renew New Membership
Membership Category Annual Dues
Primary Member $125.00

Corporate Member
(up to 4 per organization)*

$300.00
Student Member $75.00
*$75.00 per person additional corporate members

Which two best describe your responsibilities:
Planning Physician Relations/Recruiting
Sales Physician Practice Management
Marketing Network Development
Financial Planning Managed Care Contracting
Other (Specify)
 

Program Interests

a. Managed Care Issues e. ElderCare
b. Strategic Planning f. Network Integration
c. Physician Network Development g. Complementary Medicine
d. Senior Living h. Surviving as a Community Hospital

 

i. Other (Specify)
We have some volunteer roles available to maximize your investment in NESHS. Please check one or more of which you would be interested in participating:
(optional)
Program Committee Webinar Committee
Membership Committee Marketing Committee