National Hypertension Control Roundtable (NHCR) Member Application

Thank-you for your interest in joining the NHCR. Please answer the following short survey so we can learn more about your organization and why you are interested in joining. We will send you a confirmation email with 1-2 weeks after submission. Thank you!

Question Title

* 1. Please provide the following:

First and Last Name

Credentials

Title

Organization

Email Address

Phone Number

Question Title

* 2. Please select the sector that best describes your organization:

Academic Institution

Patient organization

Payer

Employer

Philanthropy

Local Health Organization

Health Care Delivery Organization

Non-profit

State Health Organization

Other (please specify)

Question Title

* 3. What is your organization currently doing to address hypertension?

Question Title

* 4. Are you interested in taking on a leadership role within the NCHR (i.e., join the Steering Committee, participate on an Action Team, etc.)?

Yes

Question Title

* 5. Please confirm the following:
I understand that registering as a National Hypertension Control Roundtable (NHCR) member allows the project support staff to send general email communications about NHCR to me and allows the project support staff to add my name, email address, organization name, and title to its database. I also understand that I can update my Communications Preferences to receive additional communications or opt-out of receiving NHCR communications at any time.

Yes