Texas Association for Healthcare Quality


Individual Member ($50.00) Newsletter Only (free)
Payment System	PayPal Secure Credit Card payment Offline Payment Pay by Check
Your First & Last name
Suffix
Credentials
Choose a Login Name (User ID) It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'
Your E-Mail Address A confirmation email will be sent to you at this address. IMPORTANT: This is the e-mail address where all official TxQuality communications will be sent.
Choose a Password Must be 4 or more characters
Confirm your password Enter password again
Work Title
Employer
Facility Type
Other (Explain)
Preferred Address	Home Work
Mailing Address
Additional Address
City
State
ZIP
Work Phone
Home Phone
Fax
NAHQ Member?	I am an NAHQ Member I am Not an NAHQ Member
Volunteer in the Organization?	TAHQ Board Second Choice
Please indicate your practice responsibilities:
Other (Explain)