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Affiliate Interest Form
GHA Affiliate Interest Form
The purpose of this form is to provide non-hospital affiliated companies the opportunity to express their interest in affiliating with GHA.
Fullname
First Name
Last Name
Phone Number
Email
Company Name
Company Type
Healthcare Organization
Government Agency
Potential Vendor
Non-Profit Organization
Interested Affiliation Type
GHA Sponsorship Program
GHA Vendor Partner Program
Society Event Sponsorship Program
GHAPac Program
Company Website
About Your Company
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