Healthcare Public Relations and Marketing Association
Application

     New     Renewal     Life    Corporate

    Date:

    First Name:

    Last Name:

    E-mail Address:

    Job Title:

    Institution:

    Street Address:

    Address continued:

    City:

    State:

    ZIP Code:

    Work Phone:

    Fax:

    HPRMA Correspondence Mailing
    Address (if different from above)

    New membership applicants only. Please complete area below in addition to above.

      Past Postition,
      if less than 6 months:

      Current job responsibilities:

      Position to which you report:

      Position(s) which
      report to you:

      Undergraduate degree/major:

      Graduate degree/major:

      Currently full-time student:

      Membership in other professional organizations:

      Referred by (if applicable)

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      Regular Members:
      $90 (renewal) or $115 (new member). The dues portion (not the processing fee) may be prorated for the time of year.

      Corporate Members:
      $200 (renewal) or $225 (new member). The dues portion (not the processing fee) may be prorated for the time of year.

      For More Information:
      contact the HPRMA office at714-890-0008or email [email protected].

      Submit Application

      or

      Clear this F orm

      Make Checks Payable:
      to HPRMA, 15564 Producer Lane, Huntington Beach, CA 92649. Membership is on annual basis from January 1 – December 31.

      To Pay With Credit Card:
      First submit this application by pressing the above button, and then click here to pay dues by credit card through a secure online service.