MSHPM Join

2008 Membership Form

To be included in the online membership directory, please submit the registration form and payment by February 29, 2008.

To process your membership application, please complete the entire application and submit. If you have any questions please call the Society at (248) 551-6402 or send an email to KCLASON@beaumonthospitals.com

* Asterisk represents required fields.

Today's Date:

* Please select member type:
New Member
Renewing MSHPM Member

Please update your contact information as appropriate.

* First Name:
* Last Name:

Business Information

* Position/Title:		* Zip Code:
* Organization:		* Country:
* Business Address:		* Work Phone:
* City:		* Work Fax:
* State/Province:		* Work Email:

Area of Professional Responsibility

* Please indicate which category best describes your area of professional responsibility.
You may only check one box.

	Planning
	Marketing
	Planning/Marketing
	Planning/Marketing/Communications/PR
	Marketing/Communications/PR
	Business Development
	Communications/PR
	Other:

Indicate the estimate number of employees in your immediate department

Are you a member of the Society for Healthcare Strategy and Market Development (SHSMD)? Yes No

* Refer a Colleague

Just complete the information below and we'll send your colleague information on joining MSHPM.

Name:
Organization:
Email or Phone

For Check payments please click print invoice,
then click proceed to complete your signup: