Associate Membership Application Form

Annual Membership Dues: $850

I hereby apply for Associate Membership for the West Virginia Hospital Association.

Membership Information

Organization:

Contact Person:

Title:

Address:

City:

State:

Zip:

Email:

Telephone:

Company Web Address:

Name of CEO/President:

Signature:

General Information:

Please furnish a brief statement (60 words) explaining the principal function and purpose of your organization and its relationship to West Virginia’s health care industry. This will be used in the WVHA Membership Directory and on the WVHA home page.

For more information, please contact Kathy Watts

Copyright © West Virginia Hospital Association

100 Association Drive, Charleston, WV 25311-1571
Phone : 304/344-9744 Fax : 304/414-0210

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