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MEMBERSHIP CRITERIA
All applicants must be sponsored by a current TRUST member.
The sponsor must:
know the applicant personally,
and believe that the applicant will be an active participant in, and asset to, the TRUST
The applicant must:
be currently active in health care or a heath related field,
have been in an influential policy-setting or leadership position for at least one year,
have made a significant contribution to healthcare or a related field, and
be committed to the advancement of women in healthcare.
* Denotes a Required Field
* Name:
* Position:
* Business Name:
Business Address:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
Business Telephone:
Business Fax:
Business E-Mail:
Home Address:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
* Home Telephone:
Home Fax:
* Personal E-Mail:
* Brief Biography, e.g. education, interests, expertise:
* Sponsor Name:
Telephone:
* E-Mail:
Amount Due:
$125.00
Women’s Health Leadership TRUST | 6320 Warren Avenue South | Minneapolis, MN 55439