Contact Us Thursday, March 11, 2010  

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Note: Please do not input any information into the form below, unless you intend on mailing in a check. If your organization has sent in a check for you, your information will be inputted for you when ACHE-Houston has received the necessary information. Thanks for your help. Email us at quantumleadership@ache-houston.org in you have questions regarding this.
 
To submit your registration fee for the year 2007 by mail, you will need to do the following:

1.  Please complete the form below and press submit to proceed.
2.  Mail your check for the appropriate amount to:

 
    ACHE-Greater Houston Chapter, Inc.
    2809 Bering Drive
    Houston, Texas 77057
 
Once we receive and process your check, we will then activate your online account. This will enable you to gain webite access using your username and password that you create below. Notification that your accout has been activated will be sent to you be email.

If you have any questions regarding your registration, send us an email at quantumleadership@ache-houston.org.

User Information
Name
(Mr. John W. Doe)
  
Home Address Line 1
Home Address Line 2
City, State, Zip    
Phone Number
(111-222-3333)
Email
Gender
(optional)
Age
(optional)
Ethnicity
(optional)
Credentials (excludes national chapter of ACHE)
(Select all that apply by holding down Ctrl & selecting.)

Your Interests
(please type up to three topics of interests, separate by a comma)
Select the committees on which you are currently serving(calendar year 2000)
(Select all that apply by holding down Ctrl & selecting.)
Are you a member of the national chapter?     
   If yes, please select status     
   If no, would you like more information?     
Are you currently a student?     
   If yes, please complete the following four fields.
   Level
   Student status
   Anticipated graduating date (mm/yy)    /
   School Attending  
Highest level of degree completed   
Year degree earned
(yyyy)
 
Employment Information
Employer
Job Title
Bus. Address Line 1
Bus. Address Line 2
City, State, Zip    
Business Number
(111-222-3333)
Fax Number
(111-222-3333)
Year began full-time healthcare employment
(yyyy)   
Select the type that most fits your organization
Select the most appropriate job level
Select your primary responsibility   
 
ACHE - Mailing Information
Send mail to
 
Please select the membership option you will be paying for
Please select the appropriate membership option
 
Login Information
User Name
Password
Confirm Password
 
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Comments to: quantumleadership@ache-houston.org

 

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