National Rural Health Association

2015 Policy Institute

Membership Form

Please fill out the following form. Required fields appear in red.

Personal Contact Information
Apply for a new membership
Renew an existing membership

Membership Level
Individual ($250)
Rural Health Clinic/Federally Qualified Health Center ($350)
Organization - 25 or fewer employees ($675 for up to 5 staff members)
Organization - 26 to 100 employees ($1,225 for up to 9 staff members)
Organization - More than 100 employees ($2,025 for up to 15 staff members)
Supporting ($3,500)
Student ($11)
Industry Individual ($400)
Industry Organization - 25 or fewer employees ($675)
Industry Organization - 26 to 100 employees ($1,225)
Industry Organization - More than 100 employees ($2,025)

Organization membership annual fees are based on the total number of employees.

Constituency Groups
Clinical Services
Federally Qualified Health Centers
Hospitals and Health Systems
Public Health
Research and Education
Rural Health Clinics
Statewide Health Resources


Please provide contact information for your staff.

Please insert my personal contact information from above.

Contact 2

Contact 3

Contact 4

Contact 5

Contact 6

Contact 7

Contact 8

Student Information

NRHA Literature
NRHA Publication
Web Search
NRHA Conference
State Rural Health Association


Credit Card
Invoice Me

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Click here to download a printable application to mail or fax. 

Please contact Sharon Hutinett, member services coordinator, at 816-423-8205 or with questions.


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