California Hospital Association
Membership Application Form Close
 

Application may be submitted online, by fax or by mail. Questions? Call (916) 552-7510.


Membership will be processed as soon as payment is authorized and reference verified.

 

1. Applicant

* Required information
First name* Last name*
Title or department
Organization
Mailing address
City State Zip
Company Phone, with area code* Direct Line
Fax
E-mail address
   

2. Reference from a CHA member hospital or health system executive.
   

* Required information
First name* Last name*
Title or department
Organization*
Phone, with area code*  
E-mail address
   

3. Membership Category
   
Executive I: organization with more than 50 employees, 10 of whom may receive membership benefits. Dues: $4,600 per calendar year.
   
Executive II: organization with 50 or fewer employees, 5 of whom may receive membership benefits. Dues: $2,300 per calendar year.
   
Associate: $550 per calendar year.
   
Personal: $375 per calendar year.
   

4. On-line Credit Card Application

 
Visa or MasterCard only. Safeguarded by encryption and SSL.
   
Dues (payable in advance)
Credit card number
Name on card
Expiration date

 

5. Complete Order

 
By:   and authorize credit card payment
   
            for fax or mail orders
   

Mail check (payable to California Hospital Association)
or credit card membership application to:

Membership
California Hospital Association
1215 K Street, Suite 800
Sacramento, CA 95814

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