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Membership Form

You may apply for membership in the PRHA in two ways:

  1. Fill out the form below, print it, and then send the form and a check for the membership fee to the address below.
  2. Fill out the form below, click Submit Electronically, and then send only a check for the membership fee to the address below.

Membership Chairman
Pennsylvania Rural Health Association
P.O. Box 1632
Harrisburg, PA 17105-1632

Make checks payable to: Pennsylvania Rural Health Association.

Investment Level (price): Organizational ($250)
(With up to 5 organizational representatives to be named.)
1.
2.
3.
4.
5.

Individual ($50)
Student ($15)

Name:

Organization:

Street Address:

City:

State:

County:

Zip:

Phone:

Fax:

Email:

©2002 The Pennsylvania Rural Health Association
PO Box 1632, Harrisburg PA, 17105-1632
Phone: 717-561-5248, Email: prha@ruralpa.org