AzHHA Membership Application Form

Instructions

Thank you for your interest in becoming a member of the Arizona Hospital and Healthcare Association.

Please select the membership type you are seeking.

If you represent a facility that is licensed as a hospital by the Arizona Department of Health Services or under a federal entity, such as IHS or the VA, please select the New Hospital Member option below.

If you represent another type of healthcare organization that may or may not provide clinical services, please select the New Healthcare Member option below.

If you are a company seeking business development opportunities, you are invited to submit a Vendor Inquiry Form.

If you have any questions, please email MemberServices@azhha.org or call (602) 445-4300.

Select An Option

New Healthcare Membership

New Hospital Member

Select Level

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameOrganization Name

Please select a valid membership option and fee item if exist