Business Name:(Required)

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Fax:

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Contact Person Title:

Contact Person Email:(Required)

Applicant Name:

Applicant Title:

Areas of Interest: Other

Payment must accompany application. Please select your preferred payment method below. You may pay by check or credit card. If paying by credit card you must contact WHCA with your credit card information at (800) 562-6170. Membership will not be valid until payment is received.

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In consideration of services provided by WHCA, signing of this application constitutes your agreement to abide by the articles and bylaws of WHCA as now in existence or hereafter amended. Dues, in accordance with the attached fee schedule, are payable upon submission of this application and annually thereafter on January 1 of each succeeding year, and do not cease until WHCA receives written notification of termination.

Washington Health Care Association

Retro Only Affiliate Membership

Membership Application