Home > Membership > Organizational Membership Application Organizational Membership Application Please use this application for Organizational Memberships in the New England Rural Health RoundTable. We also offer Individual Memberships and Corporate Memberships. Need help? For more information or assistance, please call 603-643-2800 or email membership@newenglandruralhealth.org Please complete one of the forms listed below: Use Organizational Application Form 01 (To pay offline by mail) Use Organizational Application Form 02 (To pay online with credit card) Download the printer-friendly Application (PDF/81KB) Organizational Application Form 01 (Complete this form to pay offline by mail) The cost of Organizational Membership is $125.00. Please make checks payable to: New England Rural Health RoundTable, and mail payment to: New England Rural Health RoundTable, 10 Benning Street, Box 184, West Lebanon, NH 03784 * Required Organization Information Organization Name * Mailing Address * City * State * Zip * Phone * Fax Email * Web Site Member #1 Name/Title Mailing Address Email Member #2 Name/Title Mailing Address Email Member #3 Name/Title Mailing Address Email Please check all committees your organization is interested in joining: By-Laws Finance Nominating Membership Conference   Policy Communications   To pay offline (by mail) Thank you for joining the New England Rural Health RoundTable. Organizational Application Form 02 (Complete this form to pay online with credit card) The cost of Organizational Membership is $125.00. PayPal is the secure payment processor for the NERHRT Membership Application. Complete and submit this form to pay securely online using your credit card. * Required Organization Information Organization Name * Mailing Address * City * State * Zip * Phone * Fax Email * Web Site Member #1 Name/Title Mailing Address Email Member #2 Name/Title Mailing Address Email Member #3 Name/Title Mailing Address Email Please check all committees your organization is interested in joining: By-Laws Finance Nominating Membership Conference   Policy Communications   To pay online (credit card) Thank you for joining the New England Rural Health RoundTable. to top Copyright © New England Rural Health RoundTable    Design by SeaCoast Web Design