To apply for physician membership, please complete all fields
Your MHA Physician Membership includes a paid membership to AAPL. If you are already an AAPL member, the MHA will pay your AAPL membership dues upon your next renewal with AAPL.
Affiliated Organization Information
To become a Physician Member of the MHA, you must be affiliated with an MHA Member Organization/Hospital.
Note: Forms will not be accepted if they include URLs.