AEHIS Membership Application - Healthcare Security

Personal Information

Pronoun

Name*

First Middle Last Designation

Birth Date

Graduate Degree(s)

Job Title*

Organizational Information

Organization Name*

Address*

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

Best Phone Number to Reach You*

Alternate Phone Number

Mobile Phone Number

Primary Email*

Personal Email

Organization's Website

To whom do you report? (CEO, COO, etc.)

What is the name of your organization's CIO?*

First Last

Demographic Information

Association Membership(s)

Please Specify

What are your areas of expertise?*

Which best describes your facility/organization?*

Please Specify

Number of staffed inpatient beds

Additional Information

How did you hear about AEHIS?

Hidden

Would you be willing to speak to your peers about AEHIS?

Yes
No
Not sure

Would you be interested in participating in any of the following AEHIS committees?

(Select all that apply)

Communications
The purpose of the Committee is to provide strategic planning support and policy oversight to ensure focus and direction of Communications (messaging, formats, cadence, and content, including website) and is charged with assisting in developing and executing the strategic communications plan for AEHIS and its members.
Education & Certification
The purpose of the Committee is to provide strategic planning support and policy oversight to ensure focus and direction of educational and certification programs related to cybersecurity.
Events
The purpose of the Committee is to provide strategic planning support and policy oversight to ensure focus and direction of events (virtual and in-person) and programs.
Innovation
The purpose of the Committee shall be to review the overall capabilities and strategic direction in matters related to cybersecurity in the Healthcare sector of technology, science, operations (people and process) and innovation. This will focus on identifying technology, science and innovation related risks that could have a significant impact on the sectors’ security and security operations and its pursuit of its short, mid-, and long-term strategic goals.
Membership Outreach
The purpose of the Committee is to provide direction and guidance to the Board to establish new and enhance existing relationships and partnerships with individuals and Foundation Firms within AEHIS’s target audience of organizations and individuals to evaluate membership opportunities; monitoring and examining existing programs and facilitating discussions about innovative programs and program priorities.

Phone

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