WHPRMS Member Application Form

Join the state's premier organization for health care marketing and public relations professionals today. Apply online, below, and MAIL A PRINTED COPY OF YOUR APPLICATION with your check to:

Heather Sullivan
Mercy Health System
Marketing and Public Relations
903 Mineral Point Ave.
Janesville, WI 53548

If you are a new member, you will receive a membership packet as soon as your check is received and your membership is processed.

Email directly if you need to simply update your membership profile to reflect changes in your contact information or your position.

Name:
Title (optional):
Organization:
Mailing Address :
City:
County (optional):
State:
Zip Code:
District (if known):
Telephone:
Fax: (optional)
E-mail:

I would like to participate on the following committee(s): (optional)
	Communications Review Awards Program
	Leadership Recognition Program
	Conference Planning
	Education
	Fundraising
	Membership & Retention
	e-Newsletter
	Website
Leadership Recognition - Level Attained: (select one)
	N/A
	Certified
	Accredited
	Fellow
Length of Membership: (select one)
	New
	1-2 Years
	3-5 Years
	6+ Years
Areas of Expertise: (Please check no more than 3 areas in which you would be willing to consult with other members and serve as a topical expert. These areas will be included in your directory listing. If more than 3 are checked, none will be entered.)
	Crisis Management
	Development/Fundraising
	Government Relations
	Graphic Design
	Internet/Webmaster
	Marketing
	Media Relations
	Planning
	Public Information
	Public Relations
	Publications
	Single Person Department
	Staff Recruitment/Retention
Fees:
	Regular - $75 Membership for Healthcare Communicators
	Associate - $100 Membership for individuals or organizations providing services for healthcare communicators (i.e., agencies, vendors).
	Student - $25 Membership for students or interns pursuing a healthcare communications career.

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