Thank you for your support of WiHPCA! Please complete the associate membership application thoroughly. A benefit to the associate membership is you may include an unlimited number of employees and/or staff. These individuals will have access to all of WiHPCA's benefits when they are included with your organization. WiHPCA associate member annual dues are $500/year. Once we receive your application, you will receive a dues invoice via email. Please include your organization's current logo, a brief description of your organization, and the best contact information to be listed on our website.
Name
*
First
Last
Credentials
Title/Position
*
Organization:
*
Email:
*
Work Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website
Briefly describe your organization
Current Logo
Browse Files
JPG or PNG files
Cancel
of
Best contact for you organization (to be listed on our website)
First Name
Last Name
Title
Employees you would like added to your WiHPCA associate membership. Please include full name, position and email address.
Submit
Should be Empty: