AEHIS/AEHIA/AEHIT Member Referral Program - Healthcare Security

AEHIS Member Name*

First Last

Organization Name

Security Leader Name

First Last

Security Leader Email

Technology Leader Name

First Last

Technology Leader Email

Applications Leader Name

First Last

Applications Leader Email

As a AEHIS member you may be eligible to join our other new associations AEHIT and AEHIA. If you have management responsibility for applications or technology for your organization, you can become an AEHIA and/or an AEHIT member on a complimentary basis for a year. Indicate below the associations you would like to join:

AEHIA
AEHIT

Name

This field is for validation purposes and should be left unchanged.