Member Organization Join FAHQ

* Membership Type

Member Organization $250.00 for one year For healthcare organizations providing direct patient services (includes health plan services). Organization must be located at a single address or join for each physical location. Two members are designated by the organization as Organization Representatives and are provided full benefits of Individual Membership. The representatives will be given a link for other organization staff to join as Organization Members which provides benefits of Individual Membership EXCEPT FOR ability to serve as an FAHQ Team Leader and/or be elected to a FAHQ position.

Organization Member This membership is provided to additional staff after a Member Organization joins or renews. Employees wishing to join or renew as Members must obtain an online registration link from one of your two Organization Representatives.

* Payment System

Credit / Debit Card Payments Accepts all major credit cards Offline Payment Invoice Pay by sending check or money order

Name

Anti Spam

* First Name

* Last Name

* Credentials

Example: MD, RN, CPHQ, FACHE

* Your E-Mail Address

a confirmation email will be sent to you at this address

* Password

6 or more characters using upper/lower case letters, numbers

* Confirm Password

Organization/Work Experience

* Current Organization Name

Enter Retired or Not Employed if applicable

* Current Title

Enter N/A if not employed

Current Primary Work Setting

Primary Work Setting Other

Primary Responsibility

Primary Responsibility Other

Primary Work Description

Primary Work Description Other

Years in Healthcare Quality

Phone

* Primary Contact Phone

Enter only numbers, ie, 3335551212

Primary Contact Phone Extension

Primary Phone Type

Secondary Phone

Enter only numbers, ie, 3335551212

Secondary Phone Extension

Secondary Phone Type

Preferred Mailing Address

Is this work or home?

If work, department/mailing code

* Street Address

Street Address 2

* City

* State

* ZIP Code

Additional Information

CPHQ Certified

NAHQ Member

Primary Team Interest

Secondary Team Interest

Coupon

Enter coupon code