NeRHA Membership Application

Name

Organization

Address

City/State/Zip

Phone

Email

Membership Classification

**Please note:  If you have an organizational membership,                  

             RHCs will be $50 each

Committee Interest

Please submit check to:

Nebraska Rural Health Association

2222 Stone Creek Loop South

Lincoln, NE 68512

NewRenewal

$25 Student$35 Consumer/Community Member$50 Individual/Healthcare Professional$150 Rural Health Clinics/Constituency Section ($150 for the 1st, $50 for each additional$250 Organizational (Less than $4 million operating budget)$500 Organizational (Over $ million operating budget)

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