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 ConsultantEducationWhich 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 Please indicate topics of interest for programs and webinars* ACOs, care redesign and managing care across the continuum Hospital and physician mergers, acquisitions and collaboration models Payment reform, developments in the health insurance market Network development and integration Facility planning, real estate development and physician alignment Physician relations for communication, alignment and collaboration Market assessment, forecasting models and other analytics to support business development and planning initiatives Career development 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
