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Membership Renewal Application for Organizations

The Massachusetts Health Council is a council of organizations. If you are retired or a provider that is not affiliated with a qualified organizational member, you may join as an individual.

INSTRUCTIONS
To renew your membership with the Massachusetts Health Council ...

  1. Complete either the Organization or Individual form below.
  2. Hit the "Submit" button.
  3. Follow the instructions for payment of renewal fee.


RENEW AS AN ORGANIZATION :: RENEW AS AN INDIVIDUAL

 

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

Organization Dues Schedule
July 1, 2012 to June 30, 2013

Annual Revenue

Dues Amount

Under $100,000

$120

$100,000 - $300,000

$360

$300,000 - $750,000

$720

$750,000 - $1 Million

$1,000

$1,000,001 - $1.5 Million

$1,200

$1,500,001 - $5 Million

$1,500

Over $5 Million

$1,900

Name of Organization
REQUIRED

 

Address of Organization

 

City, State, Zip

 

Telephone Number

 

Fax Number

 

E-mail Address
REQUIRED
 (very important for timely updates)

 

Web Address

 

Executive Director

 

President/CEO

 

Other contact person
(please add title)

 

Method of payment

 Check          Credit Card
   


Individual Membership
July 1, 2012 to June 30, 2013

Dues Amount

$45

Name
REQUIRED

 

Address

 

City, State, Zip

 

Telephone Number

 

Fax Number

 

E-mail Address
REQUIRED
 (very important for timely updates)

 

Method of payment

 Check          Credit Card
   

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The Massachusetts Health Council is a non-profit, non-partisan statewide organization on wellness programs, obesity prevention,
school nutrition programs, healthcare reform, healthcare cost, healthcare programs, health promotion, and health status indicators.
MA Health Council authors the annual "Common Health for the Commonweath: Massachusetts Trends in the Determinants of Health."

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Massachusetts Health Council is a non-profit, tax exempt organization.