Step 1 of 6

16%

Corporate Membership Type

Organization Name(Required)

Organization Website(Required)

Organization Type(Required)

Organization Size(Required)

Headquarters Location(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Organizational / Program Mission Statement(Required)

Primary Contact Information

Primary Contact Name(Required)

First Last

Title / Role

Primary Contact Email(Required)

Primary Contact Phone(Required)

Organizational Demographics & Sector

Primary Sector(Required)

Healthcare delivery

Public health

Education

Research

Technology

Policy / Government

Community‑based organization

Corporate / Private sector

Other

If other:

Population Served(Required)

Rural communities

Urban communities

Suburban communities

Low‑income populations

Racial/ethnic minority populations

People with disabilities

Older adults

Youth

Other

If other:

Health Equity & Disparities Alignment(Required)

Which areas of health disparities or health equity does your organization focus on? (select all that apply):

Social determinants of health

Rural health

Community engagement

Health literacy

Health systems improvement

Workforce development

Equity research

Other

If other:

List additional organizational members here:

First Name

Last Name

Title

Membership Category

Membership Type

Story Sharing & Visibility

Would your organization like to be contacted about opportunities to share your work publicly?(Required)

Yes

Maybe

If yes, what types of storytelling opportunities interest you?

Social media features

Community events

Advocacy campaigns

Written stories

Video interviews

Other

If other:

Opportunities of Interest

Policy briefings

Research collaborations

Sponsorship opportunities

Advisory roles

Community engagement partnerships

Workforce development initiatives

Speaking opportunities

Networking

Other

If other:

Acknowledgement & Consent

Membership Dues Acknowledgement(Required)

I understand that Corporate Membership dues become non‑refundable after 48 hours. Any intent to cancel must be submitted within 48 hours of registration to membership@naehd.org

I acknowledge and agree

Communication & Information Use(Required)

I consent to receive communications from NAEHD regarding membership, programs, and events.

Our organization’s information will only be used to support participation as a Corporate Member and will not be shared outside of NAEHD.

This field is hidden when viewing the form

Membership Type

This field is hidden when viewing the form

Membership Tier(Required)

Payment

Product Name

Bronze

Silver

Gold

Total

Credit Card

Feed Required: To use the Stripe field, please create a Stripe feed for this form.

CAPTCHA

Corporate Membership Registration Form (GF)

Corporate Membership Registration

Primary Contact Information

Organizational Demographics & Sector

Story Sharing & Visibility

Acknowledgement & Consent

Payment