Complete your membership online or download this PDF and mail to TPHA at the address on the form.

 

We Accept for online payments.

Organization Name :

Address Line 1: Address Line 2:

City: State: Zip:

Email Phone Fax Number

Person to whom mail should be addressed

Name*: Title

 


Dues Schedule and Benefits

$10,000 Platinum Agency Membership (includes exhibit space and full page ad)
$5,000 Gold Agency Membership (includes exhibit space and full page ad)
$2500 Silver Agency Membership (includes exhibit space and full page ad)
$1000 Bronze Agency Membership
$500 Sustaining Agency Membership
$200 Agency Membership

Agency Members will be recognized in the annual meeting program. Additional benefits for each individual level are available on our TPHA website at http://www.tnpublichealth.org.

For new Agency Membership

Sponsor

Name*: Work Location