Member Application

Thank you for your interest in the PROMIS Health Organization. We have several membership categories: Individuals: $100/yr; Students & Emeriti (Emeriti: retired individuals no longer affiliated with an academic or governmental organization): $50/yr; Institutional (Non-Profit Organizations) can register 7 representatives: $500/yr; Corporate - can register 5 representatives: $1000/yr. Choose one of the options below and you won't have to renew until December 31, 2017.
Business Information

Mailing Address

Primary Contact Information
Contact Preference:

Address

Membership Options
Membership Package: *
Payment Option: