Membership Application

Health Enhancement Research Organization Inc. (HERO) is a 501(c)(3) Non-Profit Corporation, EIN 63-1141480

Organization(Required)

This application is for organization membership.

Membership Contacts

Please provide contact information.

Primary Membership Contact

Name(Required)

First Last

Email(Required)

Credentials

Title

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website

Secondary Membership Contact

This is optional. You can add a secondary member of your organization as a contact if you choose.

Name

First Last

Credentials

Title

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Membership Type

Membership renews on an annual basis. Dues may be paid annually or in two semi-annual installments upon request. Please select from the options below. Membership dues are based on your organization's category.

Membership Type(Required)

Corporate ($7,000)

Employee HWB Provider ($7,000)

Healthcare Plan/Provider/Insurer ($7,000)

Consulting Firm ($7,000)

Association/Foundation/Non-Profit ($4,500)

Government Agency ($4,500)

University ($4,500)

Volunteer Based Health Organization ($4,500)

Billing Contact Information

Please enter the organization's billing contact information for invoice purposes.

Name(Required)

First Last

Email(Required)

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country