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Online Membership Application

Individual membership dues: $55.00

To complete your membership registration, please complete the form below to ensure that we receive all membership applications/payments.

Membership dues include CEUs offered at NAHQRS meetings. If staff from a facility (non NAHQRS members) attend a NAHQRS meeting & wish CEUs, the cost is $15 payable at the meeting attended.

Deadline for dues is January 1, 2024

If dues are not received by March 1st, membership ceases

NAHQRS Membership Application

Name and Title

Employed By:

Work Address

Work Phone

Acute care community hospital

Federal hospital (VA Hospital)

Long Term Care

Teaching/University Hospital

Managed Care Organization

Home Health Care

Psychiatric Facility

Rehabilitiation Facility

External Review (PRO)

Other

Professional Organization Membership(s) and Professional Certification(s)

NAHQ

ASHRM

CPHQ

CPHRM

Other

I am interested in becoming more involved with NAHQRS. Please contact me.

Hold an office

Serve on a committee

Host a meeting

Present at a meeting

Payment selection.

I'm sending in a check for myself.

I'm sending in a check for multiple members. (Please list members below)

I'm making an online payment.

I'm making an online payment for mutliple members. (Please list members below)

My payment was sent in via other member. (Please list member below)

If you selected other please list here. Also any other questions or comments please ask here.

If you are paying via check, please send in check payable to NAHQRS via mail, you may send the form with your check also.

Thank you so much for your membership to NAHQRS. Membership is not to be used for personal profit or business advantage.

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NAHQRS Membership Application

If you are paying via check, please send in check payable to NAHQRS via mail, you may send the form with your check also. Thank you so much for your membership to NAHQRS. Membership is not to be used for personal profit or business advantage.

If you are paying via check, please send in check payable to NAHQRS via mail, you may send the form with your check also.

Thank you so much for your membership to NAHQRS. Membership is not to be used for personal profit or business advantage.