Please complete the following form to be considered for membership to the Coalition for Health Funding. Following completion of this form, the Coalition for Health Funding Board will review your application and notify you if you are approved for membership.

For consultants, please list either your name or the name of your firm.
Type of Organization *
Were you referred by a member of the Coalition? *
Primary Contact Name *
Primary Contact Name
This person will serve as the primary contact at your organization for Coalition for Health Funding correspondence including information about payment and renewals.
Primary Contact Phone Number *
Primary Contact Phone Number
Address *
Address
Invoicing Point of Contact Name *
Invoicing Point of Contact Name
For non-profit organizations only, please provide your organization's total revenue for 2014 (line 12 on Form 990) to help us determine your dues level.
What is your "Washington Presence?" *
This question helps us determine the appropriate membership category.