Membership Type

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Name *
Title *
Address *
City/State/Zip *
Phone *
Phone TypeOffice
Mobile
Fax
Website
E-mail Address: *
Are you a member of ASHHRA *Yes
No
Number of FTEs
Number of Employees
Number of Beds
Brief Description of Duties
Type of Annual Membership *Active Before March 31: $75
Active (2nd Person in Organization) Before March 31: $50
3 Or More From Organization Before March 31: $150
Consultant Before March 31: $75
Association Before March 31: $75
Student Before March 31: $20
Active After March 31: $90
Active (2nd Person in Organization) After March 31: $60
3 Or More From Organization After March 31: $175
Consultant After March 31: $90
Association After March 31: $90
Student After March 31: $30
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