Affiliate Application Form

Healthcare Leaders Association of Northeast Florida values its Affiliate Members!

Network with local medical practice decision makers! 

Request to join by filling out the application below. 

 

Affiliate Member Benefits Include:  *NEW Affiliates tab coming to the HLANEFL website with your company logo, contact info & brief description of services.  *Networking opportunities with practice managers & decision makers  *10 educational meetings per year  *Attendance at annual membership appreciation event at no charge  

Important Information: 

  • Affiliate Membership Cost: $350 annual dues. 

Email Address: *
First Name: *
Last Name: *
Title:
Practice/Organization Name: *
Affiliated
(If affiliated with another organization through ownership or legal affiliation,
please indicate the name of the organization.) :
Business Address: *
Business Address 2:
City: *
State: *
Zip: *
Phone: *
Fax:
How did you hear about NFMGMA:
Referring member or organization:
Please list any topics you would like to have a guest speaker present:
Are there any MGMA benefits you'd like to learn more about?:
Provide name/contact information for anyone who would benefit from becoming a member:
For potential Affiliate Members, please describe in detail the services your company can provide and what percentage of your business is devoted to medical practices:
Affiliate's Industry:
Accounting
Attorney-Healthcare
Attorney-Employment
Banking
Billing
Call Center
Collections
Communications
Employee Benefits
Financial Investing
Healthcare Management/Consulting
Human Recourses
Information Technology
Malpractice Insurance
Marketing
Medical Supplies/DME
Real Estate (Sales/Lease/Purchase)
Staffing/Recruiting
Training/Education