Membership Registration

Membership Plans

Save 40% on the 3 year plans.

Individual Memberships

Basic Member $55.00/year

Basic Member $125.00 every 3 years

Agency Memberships

Basic Agency $350.00/year

Basic Agency $699.00 every 3 years

* All NAMIHP membership plans renew automatically unless canceled at least 7 days prior to the renewal date.

Member Information

Email Address*

First Name*

Last Name*

Password*

Confirm Password*

Agency/Organization Information

Title*

Agency/Organization Name*

Category of MIH*

I hereby grant NAMIHP permission to utilize this information and/or image(s) for announcements, media, marketing, and other channels, for the purpose of advocacy and awareness for the field of mobile integrated health, community paramedicine, and to showcase MIH/CP work. I also attest that I have the authority to grant this permission.

I Agree

Upload your agency MIH/CP photo

Upload

Photo Caption

I attest these photo(s) contain(s) no patient or protected health information. If my submission contains patient information which cannot be removed, either in photo likeness, protected health information, or otherwise, I attest that I have already obtained consent from any and all patients or individuals featured, and can provide copies of consent at notification of award.

I Agree

Address Information

Street 1

Street 2

City

Country

State

Provinces and Territories

Zip Code

Postal Code

Telephone

Additional Agency Members

Only complete this section if you are purchasing an Agency Membership.

Agency User 2 First Name

Agency User 2 Last Name

Agency User 2 Email

Agency User 3 First Name

Agency User 3 Last Name

Agency User 3 Email

Agency User 4 First Name

Agency User 4 Last Name

Agency User 4 Email

Agency User 5 First Name

Agency User 5 Last Name

Agency User 5 Email

Agency User 6 First Name

Agency User 6 Last Name

Agency User 6 Email

Agency User 7 First Name

Agency User 7 Last Name

Agency User 7 Email

Agency User 8 First Name

Agency User 8 Last Name

Agency User 8 Email

Agency User 9 First Name

Agency User 9 Last Name

Agency User 9 Email

Agency User 10 First Name

Agency User 10 Last Name

Agency User 10 Email

Only fill in if you are not human

Membership Registration

NAMIHP Contact Information

Address

Phone

Email

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