Membership Form

Are you:
Applying for new membershipRenewing your membership

What level of membership?
Regular Membership - $250Associate Membership - $300 (Business Membership)

Name:

Administrator License Number:

Home Address:

Birthday:

Email:

Facility:

Facility Address:

Survey Region:

Business Phone Number:

Would you be interested in joining any committee?
Convention Committee: Chooses the site, plans the educational programming and social agenda for the annual convention and Winterfest Conference. Responsibilities include budgeting, marketing, and coordinating events.Education Committee: Addresses the education needs of administrator and long-term care staff to enhance professionalism and quality of care. Responsible for the planning and execution of all educational programs for administrators and staff.Government Liaison Committee: Responsible for developing and implementing a comprehensive governmental relations program which includes, but is not limited to, reviewing legislation and regulatory proposals, notifying members of any concerns, proposing official actions to board, maintaining the flow of information between MANHA and officials and agencies.Membership Committee: Responsible for marketing MANHA and creating a stronger member base.

Additional Information