Membership Application Join the state's premier organization for health care marketing and public relations professionals today. If you are a new member, you will receive a membership packet as soon as your check is received and your membership is processed. Name* First Last Email* Password* Enter Password Confirm Password Job Title*OrganizationPhone*LinkedIn Profileex:http://www.linkedin.com/in/exampleuser03Ext.Primary Work Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County*District (Select One)* North Southeast Southwest North District Counties: Ashland, Barron, Bayfield, Buffalo, Burnett, Brown, Chippewa, Clark, Door, Douglas, Dunn, Eau Claire, Florence, Forest, Iron, Jackson, Kewaunee, Langlade, Lincoln, Marathon, Marinette, Menominee, Oconto, Oneida, Outagamie, Pepin, Pierce, Polk, Portage,Price, Rusk, Sawyer, St. Croix, Shawano, Taylor, Trempealeau, Vilas, Waupaca, Washburn and Wood Southeast District Counties: Calumet, Dodge, Fond du Lac, Green Lake, Jefferson, Kenosha, Manitowoc, Milwaukee, Ozaukee, Racine, Rock, Sheboygan, Walworth, Washington, Waukesha, and Winnebago Southwest District Counties: Adams, Columbia, Crawford, Dane, Grant, Green, Iowa, Juneau, LaCrosse, Lafayette, Marquette, Monroe, Richland, Sauk, Vernon, WausharaReferred ByIf you were referred by an existing member, please mention them here.Membership Type*Regular - ($100) Membership for Healthcare CommunicatorsAssociate - ($125) Membership for individuals or organizations providing services for healthcare communicators (i.e., agencies, vendors)Student - Faculty ($25) Membership for students, Communications faculty or interns pursuing a healthcare communications careerCommittee Work Groups: as a member benefit, you can participate on committee work groups in areas that interest you. Check the areas in which you would like further involvement. (optional) Communications Review Awards Program - Participate in judging entries that come in for the awards program Leadership Recognition Program - Review and score applications received for the recognition program Membership Recruitment and Retention - Offer support in recruiting and retaining WHPRMS members. Mentorship Program - Mentor an entry-level marketing professional in the organization, or request to be mentored by a more senior-level professional in the organization. Payment Method*OnlineCheckTo pay by check, please submit this form with payment in the amount correlating to your membership type to: Clair McNamara 580 N Washington St. Janesville, WI 53548 Please ensure your name is referenced on the check provided. If names are not included on check payments, this could result in a processing delay with your membership. These instructions will also be emailed to you.NameThis field is for validation purposes and should be left unchanged.