2009 Ihmprs Membership Application

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2009 Membership Renewal & Application Form Check One:

 Professional Membership ($40)  Renewal  New Member

 Student Membership ($20)

Please Print

Name _________________________________________________________________________ Title __________________________________________________________________________ Organization ___________________________________________________________________ Address _______________________________________________________________________ City _________________________________ Phone (

State ____ Zip Code _____________________

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Email Address _______________________________

NEW MEMBERS ONLY: Please complete the section below. This application is subject to approval at the next meeting of the Board of Directors of the Indiana Healthcare Marketing and Public Relations Society. You will be notified of the Board decision. Payment must accompany application. Nature of Duties (please check all that apply):

Public Relations

 Marketing

Planning

Newsletters

Other (please explain)____________________________________________________ Length of Time in Present Position ______ Previous Public Relations or Marketing Positions Position

Organization

Years

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Please make checks payable to IHMPRS Please mail the completed application form with your payment to: Indiana Hospital & Health Association 1 American Square Suite 1900 Indianapolis, IN 46282