FBHA Business Partner Application

FBHA Business Partner Application

Please fill out the information below to apply as a business partner with the Florida Behavioral Health Association. Applications will be voted on at the next schedule meeting of the FBHA Board of Directors. Note: MCOs must join at the Platinum level & Managing Entities must join at the Gold level.
Company Name
Company Contact Person

First Name Last Name
Contact Email
CONTACT Title
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Website
Phone Number
Corporate Partner Level
DESCRIPTION OF SERVICES YOUR COMPANY PROVIDES
Company Logo

Browse Files

Cancel of
Company Information
Level of Partnership (Select one)

Platinum- $15,000 (MCOs must join at this level) Gold- $7,500 (MEs must join at this level) Silver- $5,000 Bronze- $2,500
Additional Company employee to add to membership lists

First Name Last Name
Email
example@example.com
Should be Empty:

Corporate Partner Level