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Membership
EHL Membership
If you are interested in becoming a member of Emerging Health Leaders please fill out the form below and indicate what node(s) you would like to join. If you have any trouble completing this form, cannot pay online or don't see a local node, please email
us
.
Name
*
First
Last
Preferred Email
*
Enter Email
Confirm Email
This is the email that we will use to contact you.
What city/town do you reside in?
*
This helps us understand where members are coming from and gives insight into where to launch new chapters/nodes.
What node do you wish to join?
*
Calgary
Edmonton
Hamilton
Toronto
Vancouver
National (I don't live close to other Nodes)
Please choose the node you would like to be affiliated with.
2023-2024 Calgary Membership Fee
*
Price:
$ 25.00 CAD
2023-2024 Edmonton Membership Fee
*
Price:
$ 25.00 CAD
Sept 2023- June 2024 Vancouver Membership Fee
*
Price:
$ 25.00 CAD
2023-2024 Toronto Membership Fee
*
Price:
$ 0.00 CAD
Edmonton News Letter
*
Price:
$ 0.00 CAD
Total
$ 0.00 CAD
Are you a renewing member?
Yes
Credit Card
If your local node requires payment please provide your credit card information. If you do not have a credit card email co-chairs@emerginghealthleaders.ca for alternative payment options.
American Express
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Visa
Card Number
Month
01
02
03
04
05
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07
08
09
10
11
12
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Expiration Date
Security Code
Cardholder Name
What updates are you most interested in?
Newsletter (industry news, EHL activities)
Local area updates (events, announcements etc.)
Promotions (e.g. job postings, continuing education or leadership programs)
Other
This is an informal poll to see what our members want to hear about. You will automatically be added to the Emerging health Leaders mailing list, but we send you and email to confirm you want to join.
What best describes your work?
*
Clinical practice
Administration or management
Government or policy
Research or education
Private sector
Non-health/healthcare related
Other
Organization
Please provide your primary organization affiliation (work, school, etc.)
Role
Please describe your role with your organization or profession
How many years of work experience do you have?
Please count only years when you were not enrolled in full-time education and include non-healthcare related years of work. If you are currently in school and have not started work, enter zero "0"
How did you hear about Emerging Health Leaders?
Website
Mailing List
LinkedIn
Twitter
Facebook
Word of Mouth (friend, colleague, boss etc)
Other
Name
This field is for validation purposes and should be left unchanged.