PRHA Membership Info - 2022
Please fill out the following form for PRHA membership for 2022. A PayPal link will be provided at the conclusion of the form if that is your preferred payment method. If you are paying by check, please complete the form and send the check to:

Pennsylvania Rural Health Association
P.O. Box 24
Patton, PA 16668

If you have any questions, please reach out to paruralhealthassociation@gmail.com

Thank you for your membership!
New or Returning Member? *
First and last name
Email *
Phone number *
Mailing Address *
Organization or School *
What type of membership?
Clear selection
If you selected "Organizational" in the previous answer, please list up to 5 representatives:
How are you paying for your membership? *
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