Personal Information - Marketing and Public Relations Member Validation Intake Form

Marketing, Communications and Public Relations Network

We're launching an exclusive online community for Missouri hospital marketing, communications and PR professionals this fall — and we want you there from day one. Update your information below (or forward to a colleague who should be included) so we can get you connected as soon as it goes live.

Contact Information

Already submitted your updates but need to make an edit?

Registration Type

Marketing and Public Relations

* Select Your Member Hospital From the DropdownThis question is required.

Type to search.

If you have an individual membership, please select "Individual Paid Member" from the dropdown list.
If you work in a clinic, please select your parent facility from the list.
If you do not belong to an MHA-member hospital, health system or professional membership group listed in the dropdown, please select "Other".

* Prefix

* First name

* Last name

Example: Mr., Mrs., Ms., Mx., Dr.

Preferred Name if different from First Name

Credentials

* Email address

* Work Phone Number

Mobile Phone Number

* Job Title

* Facility Name

Note: Please do not abbreviate.

Note: Please do not abbreviate.

* Facility Street Address

* Facility City

* Facility State

* Facility ZIP/Postal code

Forward Online Communities Record Update

Invite your colleagues to join the community using the button below.