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.)* Yes No Please check the category that best describes your position, not title* Chief Executive/Senior Vice President Dept Head/Director Analyst/Associate Manager Consultant Please describe your work setting* Hospital System Independent Hospital Physician Organization Architect/Engineering Health Plan Independent Consultant Consulting Firm Education Which 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)* $300.00 Additional Corporate Members $75.00 Primary Member $125.00 "In Transition" $75.00 Student Member (Must be full-time or part-time undergraduate student, or full-time graduate student) FREE 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
