CHA Individual Membership Application Form

BECOME A MEMBER OF THE CATHOLIC HEALTH ASSOCATION!

The proof of love is in the works. Where love exists, it works great things. But when it ceases to act, it ceases to exist. -- Pope St. Gregory the Great

The Catholic Health Association of Texas, based in Austin, represents individual and organizational members who are dedicated to the healing ministry of Jesus Christ and the social teachings of the Catholic Church which stress the inherent dignity of all people.

Our MISSION:

The Catholic Health Association of Texas responds to the call of the Gospel by advocating for health care policies and programs that provide quality , affordable and accessible health care for everyone in Texas. We focus especially on the needs of the poor and vulnerable people in our state and promote collaboration among Catholic health care providers, other ministries and organizations.

CHA of Texas and our members are committed to serving Texas and its residents through leadership on health policy issues and working towards a more coordinated and comprehensive health system. Through our words and actions, we focus on healing for the whole person - mind, body, and spirit.

When you join CHA of Texas, you will receive an advocacy toolkit that outlines effective actions you can take to make your voice heard at the Texas State Legislature.
You will receive our monthly e-newsletter.
You can sign up to receive regular advocacy alerts about proposed legislation, regulations, public hearings and other important information.
You will receive copies of any reports issued by CHA of Texas such as our Directory of Catholic Health Care in Texas, and
You will receive a 10% discount to any educational seminars offered by CHA of Texas.

So fill out this form today and become an individual member of the Catholic Health Association of Texas. Once you've submitted your application please mail your check for 2004 Membership Dues to: CHA of Texas, P.O. Box 15364, Austin, Texas, 78761-5364.

If you have any questions or need additional information, please call or email us at: 512.465-1521 or cha@tha.org. To learn more about our association and the ministry of Catholic health care in Texas, visit our website at www.chatexas.org.

Thank you for your interest. We look forward to your active participation in our association!

Your First Name*

Your Last Name*

Your Home Address*

City*

State*

Zip*

Daytime Phone*

Home Phone

Cell Phone

Email Address*

Employer

Birthdate

Do you agree to support the Ethical and Religious Directives for Catholic Healthcare? Yes No

Your Catholic Parish

Please select your membership type.
Individual ($50) Student ($30)

Additional contribution to CHA's Annual Msgr. William Broussard Scholarship Fund for Catholic Students in Health Care
$ .00

Additional contribution to assist CHA's health care ministry and advocacy efforts
$ .00

NOTE: Your membership application will not be processed until payment is recieved. Please mail your payment to CHA of Texas, P.O. Box 15364, Austin, Texas, 78761-5364.