MHA Membership Application

To apply for membership, please complete all questions

Submitter Information

Organization Information

Primary Contact Information

Chief Executive Officer Information

Member Hospital Endorser

(To be signed by the Chief Executive Officer or his/her designee)
I certify on behalf of my organization that I have read the bylaws of the MHA and agree to support the purpose and objectives of the MHA. I understand that this application, upon being filed, will be referred to the MHA Executive Committee for consideration. I also understand that before becoming a member, we must remit the dues as specified.

* Required

MHA 100 Year Anniversary

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