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TASK FORCE ASSIGNMENT FORM

If you are interested in joining the Council, please submit this form along with your membership application. If your company is currently a member of the Council and you would like to join one of our task forces, please submit this form. To check your membership status click here, to learn more about our task forces click here. Memberships are corporate and there is no limit to the number of individuals who can participate.

Please check beside the task force(s) on which you would like to serve:

COUNCIL STRATEGIC COMMITTEES:
Public Affairs & Programs Committee
International Committee
Membership Development Committee
New Business Committee

PROJECT TASK FORCES:
Community Health & Wellness
Design & Construction Task Force
Health & Technology Task Force
Health Strategies Roundtable
Hospital CEO Roundtable (Hospital CEOs/Presidents Only)
Long Term Care / Home Health Task Force
Medical Device Action Alliance (MDAA)
Regulatory Affairs Roundtable (Medical Device / Healthcare
     Manufacturing Companies Only)

* Name and Title:
* Company/Organization:  
* Address:
* E-Mail Address:
* Phone:
Fax:
Your Assistant:
* = Required Fields

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The Health Industry Council • 3001 Skyway Circle North, Suite 100
Irving, TX 75038
Telephone: 972-256-2291 • Facsimile: 972-570-8037
Email: nanc7@aol.com