NJAMHAA Integrated Healthcare Council Application
The New Jersey Association of Mental Health and Addiction Agencies Inc. (NJAMHAA) facilitates an Integrated Healthcare Council, in an effort to provide avenues to foster partnerships between a variety of companies offering products and services to behavioral healthcare providers. The 160 members of NJAMHAA represent most of the behavioral healthcare providers in New Jersey and may be found in every county and almost every community statewide. They serve more than 500,000 children and adults each year and employ a significant segment of the state’s workforce.

NJAMHAA’s Integrated Healthcare Council will enable you to share information and network with the agencies that provide behavioral health services in New Jersey, and jointly adapt to the changes in the healthcare system.

If you would like to download a PDF version of this application and mail it to the office, please go to: http://www.njamha.org/links/Integrated_Council_Application_FY_2018.pdf

Please provide NJAMHAA with the following information:

Name
Your answer
Title
Your answer
Company Name
Your answer
Address 1 (Street, Unit)
Your answer
Address 2 (City, State, Zip)
Your answer
Phone Number
Your answer
Fax Number
Your answer
E-mail Address
Your answer
Company Website
Your answer
Number of Employees
Your answer
Number of Covered Lives (If Applicable)
Your answer
Please describe your organization:
Your answer
Your information will be reviewed by NJAMHAA, and you will be contacted shortly regarding your application.

Dues must be paid with submission of application; otherwise, membership will not be activated. Thank you for your application and payment!

The dues structure is as follows:

Non-managed care companies: $1,265

Managed Care Organizations:
• 1 million to 5 million covered lives: $1,265
• 5 million to 25 million covered lives: $1,856
• More than 25 million covered lives: $3,096

Please enclose your check, made payable to NJAMHAA, along with this application form and mail it to: NJAMHAA, 3635 Quakerbridge Road, Suite 35, Mercerville, NJ 08619. If you need additional information, please contact Shauna Moses, Vice President, Public Affairs and Member Services, at (609) 838-5488, ext. 204,
or e-mail at smoses@njamhaa.org.

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