PRHA Membership 2024

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Please fill out the following form for PRHA membership for 2024. A PayPal link will be provided at the conclusion of the form if that is your preferred payment method. If you are paying by check, please complete the form and send the check to:

Pennsylvania Rural Health Association
P.O. Box 24
Patton, PA 16668

If you have any questions, please reach out to paruralhealthassociation@gmail.com

Thank you for your membership!

New or Returning Member? *

Renewing Membership

New Member

How are you paying for your membership? *

PayPal

Check

Already Paid - Updating Mailing Info

Name *

Email *

Phone number *

Mailing Address *

Organization or School

What type of membership?

Organizational - 5 members ($200)

Organizational - 10 members ($250)

Organizational - 10+ members ($300)

Individual ($50)

Student ($10)

Other

Clear selection

If you selected "Organizational" in the previous response, please list up to 5 representatives. Please include name and an email address for all representatives.

If you selected "other" please specify who you are paying for and what type of membership they should receive:

Submit

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