MEMBERSHIP FORM

NOTE: The fields marked with * are required and must be filled. If you don't have information for any of those fields simply put "na" and continue to the next field. Thank you.

By submitting this form you agree that you have read and accepted the Object Management Group Inc. Privacy Policy and Terms and Conditions of Membership, and you consent to the processing of your data for the purpose of using this service.

Select Membership Level Based on Your Organization's Annual Revenue and Type of Organization*:

US $500 million - $21,500

US $100-499 million - $11,000

US $10-99 million - $5,500

US $0-9 million - $3,000

US $0-2 million (Small consultancy) - $1,500

Government - $12,850

Professional healthcare society (more than $9 million) - $5,000

Professional healthcare society ($0-9 million) - $3,000

University - $550

ORGANIZATION GENERAL INFORMATION:

PRIMARY REPRESENTATIVE FROM YOUR ORGANIZATION:

Check if the Address is the same as "Organization Info"

ALTERNATE REPRESENTATIVE FROM YOUR ORGANIZATION:

Check if the Address is the same as "Organization Info"

MARKETING CONTACT FROM YOUR ORGANIZATION:

Check if the Address is the same as "Organization Info"

Contact BPM+ Health by e-mail HERE or by calling +1-781-444-0404. BPM+ Health is headquartered in MA, USA.

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MEMBERSHIP FORM

Select Membership Level Based on Your Organization's Annual Revenue and Type of Organization*:

ORGANIZATION GENERAL INFORMATION:

PRIMARY REPRESENTATIVE FROM YOUR ORGANIZATION:

ALTERNATE REPRESENTATIVE FROM YOUR ORGANIZATION:

MARKETING CONTACT FROM YOUR ORGANIZATION:

BILLING CONTACT INFORMATION:

Voting Representative From Your Organization:

HOW DID YOU LEARN ABOUT BPM+ HEALTH?

METHOD OF PAYMENT*:

Please review all information prior to submitting this form. Please print a copy of this form for your records.