Membership Application	Date: Click to enter a date.

Company/Organization Information

Organization: Click to enter text.

Address: street address

City: city State: state Zip: zip

Website: website

Number of employees (locally): #

Do you have a large conference room or training room? Yes/No

How many people will it hold? #

Contact Information

PRIMARY Contact

The main point of contact for correspondence at your organization. This includes benchmarking questions, class host coordination, annual surveys, etc. You will automatically be put on the distribution list and receive a login for our website.

Name:

Title:

Email:

Phone:

Select one:

☐ I’d prefer all training/benchmarking/networking requests filter through me.

☐ Others at my organization will be encouraged to contact NWHPEC directly.

SECONDARY Contact

Will receive correspondence if the primary contact is not available. Will automatically be put on the distribution list and receive a login for our website.

Name:

Title:

Email:

Phone:

BILLING Contact

Will receive all invoices and payment questions.

☐ Same as primary contact

If applicable:

Name:

Email:

Phone:

Membership invoices are pro-rated during first year of membership, then invoiced annually in January.

Classes are invoiced approximately 10 days prior to each event.

The following payment methods are available, in order of preference: Direct/ACH, Check, Credit Card (this incurs fees).

Executive Contacts We hold exclusive events for executives and senior leaders, this include keynotes by well-known authors and leadership experts. They will receive a personal invitation from our board of directors to participate. Please include contact information for your executive team/senior leadership team. (Ex: CEO/President, CFO, COO, VPs/Directors)

Name	Title (role/position)	Email Address	Phone Number

Other Contacts

Please list key stakeholders in your organization who you would like to: receive all announcements via our NWHPEC distribution list (approximately 3-4 per month)

Name	Title (role/position)	Email Address

This list serves as an “opt in” to receive our email communication.

Company Bio Please include a short company bio (2-3 paragraphs) that will be sent out in an announcement to our members. The text is typically pulled straight from your website. It can include things like who you are, what you do, who you serve, your website address, etc. Also include information about where you are located, the number of employees at your site, and a few sentences about your continuous improvement journey. Please attach an image file with your company logo.

This information will be distributed via email, posted to the NWHPEC LinkedIn private community group, and a condensed version will be posted on our NWHPEC company LinkedIn page.

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Paste company bio here

Next Steps

Send your completed application and organization’s logo to jennifer@nwhpec.com.

Once we receive your application, NWHPEC will:

Create a prorated invoice and send it to the billing contact at your organization.

Add identified individuals to our distribution list and create website logins.

Add your organization to our website: https://nwhpec.org

Send a welcome email to your team with a brief “what to expect” and “how to get value from your membership”.

Announce you to our members (email, LinkedIn (company/private group), and Facebook private group)