Apply for Membership

To apply for your organization's membership with LAHP, please complete the form. Afterward, you will have the option of submitting payment for your annual dues online. You may also choose to pay by check or speak with a LAHP representative about payment. Please note that filling out an application does not guarantee membership.

To discuss membership information, contact LAHP or call (225) 378-3205 to arrange for discussion with an LAHP representative. Please include your name, address and phone number in any written inquiries.

Organization

Name of Primary Contact

First Name

Last Name

Title

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Cell Phone

(###)

###

####

Email Address

Organization Website

http://

Additional Company Representatives

Anyone else you'd like to receive LAHP emails? Please provide name(s) and e-mail address(es).

Areas of Interest

Please select the LAHP committee(s) in which you are interested in participating.

Education Committee (open to all members; advises on and helps plan LAHP events)

Membership Committee (open to all members; helps promote association membership)

Legislative Affairs Committee (open to Health Benefits members; receives updates and advises on legislative activities)

Regulatory Affairs Committee (open to Health Benefits members; receives updates and advises on regulatory activities)

Medical and Pharmacy Directors Forum (open to medical directors of Health Benefits members)