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About Us
Staff
News
Federal Policy
Legislation
Regulations
Reports
Resources
Events
Past Events
Become a Member
Membership Application
Contact
Membership Application
Step 1 of 3
33%
Coalition Member Criteria
Only Critical Access Hospitals are eligible for membership.
CAH Hospital Name
*
CAH Address
*
Street Address
Address Line 2
City
State
ZIP
Choose One
*
Independent
Part of a Health System
Owned or Managed by Another Company
Please indicate organization:
*
Primay Contact Information
Primary Contact to Coalition
*
First
Last
Contact's Email
*
Contact's Office Phone
Contact's Cell Phone
Membership Dues
The fee for joining the CAH Coalition is $5000 a year, to be paid quarterly, or one annual fee of $4800. Invoices will be emailed to the primary contact for each CAH. For CAHs in a health system, owned or managed by another company, dues payments are structured as follows:
1st CAH in a state is $5000 a year (paid quarterly) or $4800 in one payment.
2nd - 5th CAH in same state is $2500 each per year.
If more than 5 CAHs in a single state, please contact us.
A member may withdraw from the CAH Coalition with 30-days written notice to the CAH Coalition.
Check One
*
Annually
Quarterly
Signature
*
Phone
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