NJAMHAA Life Sciences and Innovation Council Membership Application
The New Jersey Association of Mental Health and Addiction Agencies, Inc. (NJAMHAA) Life Sciences and Innovation Council provides avenues to foster partnerships between pharmaceutical companies and the community providers of behavioral health services. The 160 hospital-based and freestanding 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.

Membership in NJAMHAA’s Life Sciences and Innovation Council will enable your company to share information and network with the agencies that are providing mental health and substance use treatment services in New Jersey.

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/LSI_Council_Application_FY_2018.pdf

Please provide NJAMHAA with the following information:

Name
Your answer
Title
Your answer
Company Name
Your answer
Address (Street)
Your answer
Address 2 (Unit, Suite, P.O. Box, etc.)
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Main Telephone Number
Your answer
Fax Number
Your answer
E-Mail Address
Your answer
Company Web Site
Your answer
Number of Employees
Your answer
Membership dues for the NJAMHAA Life Sciences and Innovation Council are currently set at $4,335 annually (due on July 1 of each year, unless your organization operates on a calendar year budget) for one corporate representative per year.

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

Please enclose your check, made payable to NJAMHAA, and mail it to NJAMHAA, 3635 Quakerbridge Road, Suite 35, Mercerville, NJ 08619.

If you have any questions or need additional information, please contact Shauna Moses at (609) 838-5488, ext. 204, or by e-mail at smoses@njamhaa.org.

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