Membership Application (For New and Renewing) Name* First Name Last Name Title*Organization*Address* Street Address City State / Province / Region ZIP / Postal Code Telephone*Email* Years of service in healthcare*Highest level of education attained*Are you age 30 or below? (For entry into the Early Careerist Network.)*YesNoPlease check the category that best describes your position, not title*Chief Executive/Senior Vice PresidentDept Head/DirectorAnalyst/AssociateManagerConsultantPlease describe your work setting*Hospital SystemIndependent HospitalPhysician OrganizationArchitect/EngineeringHealth PlanIndependent ConsultantConsulting FirmEducationWhich two best describe your areas of responsibility?* Strategic Planning and Business Development Physician Relations/Recruiting Network Development Marketing Communications Facility Planning Finance Physician Practice Management Managed Care Contracting Other Volunteer* Program Webinar Marketing Membership Not at this time Are you interested in participating in a Committee?Membership Category Annual Dues*Corporate Member (up to 4 per organization)*Additional Corporate MembersPrimary MemberStudent Member or "In Transition"Additional corporate members can be added for only $75.00/person. Contact Donna Powell at admin@neshs.org to see if your company has a corporate membership. Consider including Chief Medical Officers, service line leaders (physician and administrative), analysts and other members of your organization involved in strategic planning and business development.Total $0.00
