Application for HHRMAC Membership

To apply for membership, please fill out the form below and click "Submit."
Required fields are listed in red.

Please DO NOT enter any information in this field, as it is used to trap spam.
Name:
Position / Title:
Healthcare Organization:
Organization Address:
City, State, Zip:
Phone:
Fax:
E-mail:
Previous Position / Title:
Organization:
City, State:
Dates Employed:	From       To
Personal Information:
Home Address:
City, State, Zip:
Phone:
Fax:
E-mail:
Please indicate mailing address preference:
Office           Home
For first time members: please answer the following questions:
Who was your referral source?
Why are you interested in joining HHRMAC?
Membership Category:    Active    Student
Dues:
Dues for active members are $75 per year. Dues for student members are $50 per year.
Please make checks payable to:
Healthcare Human Resources Management Association of California (HHRMAC)
and send to:    ATTN:  Human Resources Coordinator 515 South Figuroa Street Suite 1300 Los Angeles, CA 90071