Membership Application

If you're looking for ways to increase the value of your healthcare dollars, we invite you to first, contact us. The details on the benefits of being an HPA member are located in Our Work, but talking to HPA staff and learning from us is the best way to understand how membership can support your business. Below is an application for businesses ready to start their membership with HPA.

Name of Company/Organization

Your Name

First Name

Last Name

Title

Member Representative

Who would you like to represent your organization at the Alliance? (Please note: Member representatives are encouraged to attend meetings and participate in Alliance programs)

First Name

Last Name

Title

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Other

How many employees receive health benefits through your organization?

Are you interested in data membership?

Comments/Questions?