Health Ministries Association / HMA MEMBERSHIP FORM

New Member  Renewal

Member Types: Individual (1 member) $40.  Congregational (2 members) $80. (Requires two (2) completed forms)

Institutional/Organizational (5 members) $250. (Requires five (5) completed forms)    

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NAME: First Middle Initial Last

MAILING ADDRESS: Street City

State/Province Zip/Postal Code Country

TELEPHONE: Home Work Fax

E-MAIL ADDRESS:

FAITH GROUP: Christian Jewish Buddhist Muslim Hindu

Other Denomination or Division (if applicable)

MEMBERSHIP MODE (select one) Parish Nurse Lay Health Minister Allied Health Professional

Clergy/ Chaplain Health Educator Program Coordinator      Other

VOLUNTEER TIME WITH ONE OF THE NATIONAL COMMITTEES: Chapter Development

Newsletter Development Finance Membership Practice and Education Resources

Public Relations I do NOT wish to have my Name,Addr,Phone,etc. published in the HMA Membership Directory

Name of Congregation, Institution or Organization

Address: Street City

State/Province Zip/Postal Code Country

Chapter Name (if applicable)