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YSHC General Membership Application
ORGANIZATION INFORMATION
DESIGNATED REPRESENTATIVE
Membe
r for the purpose of voting
CONTACT PERSON
Primary person who manages membership & receives the communication, if different from above
MEMBERSHIP LEVEL
New member
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Affiliate Membership
(individual/Non-Healthcare Entities)
$100
$100
$200
$300
WHY DID YOU DECIDE TO JOIN OR RENEW?
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Colleague Recommendation
YSHCF website/social media
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