Massachusetts Health Council Nonprofit Donations Online

	Home \| Make an online Donation \| Members Dues Prevention Today for a Lifetime of Health 90 Years of Promoting Prevention and Wellness

Massachusetts Health Council Member Application

To become a member of the Massachusetts Health Council ...

Complete the form below.
Print the page.
Attach your check made payable to "MA Health Council"
Mail your application and payment to:

Massachusetts Health Council, Inc.
73 Oak Street - 1st Floor
Newton, MA 02464-1438

Amount due is on a sliding scale.
Please submit the appropriate amount for your organization.

Dues Schedule

Annual Revenue

Dues Amount

Under $100,000

$100

$100,000 - $300,000

$300

$300,000 - $750,000

$600

$750,000 - $1.5 Million

$750

Over $1.5 Million

$1,000

Name of Organization

Address of Organization

City, State, Zip

Telephone Number

Fax Number

E-mail Address
(very important for timely updates)

Web Address

Executive Director

President/CEO

Other contact person
(please add title)

The Massachusetts Health Council is an organization of organizations. This category is only available to people who have retired from a qualified organization or do not work for a qualified organization; e.g., an independent social worker.

If your organization is a member and you would like a separate individual membership or if you are not affiliated with a qualified health care organization, are retired or work as a consultant and wish to join, please fill out the membership application below.

Individual membership dues are $50.00

Name

Title

Address

Telephone Number

E-mail address for timely updates

Name of Applicant

Date

PAY DUES ONLINE

INDIVIDUAL MEMBERSHIP

Dues Amount

$50

ORGANIZATION MEMBERSHIP

Annual Revenue

Dues Amount

Under $100,000

$100

$100,000 - $300,000

$300

$300,000 - $750,000

$600

$750,000 - $1.5 Million

<$750

Over $1.5 Million

$1,000