Corporate Member Application | International Health Facility Diversion Association

Corporate Member Application

IHFDA Corporate Member Application

Name of Company

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Company Point of Contact

The person responsible to be the liaison with IHFDA

First Name

Last Name

Email

Phone/Mobile

Corporate Member Level

Platinum - $10,000

Gold - $5,000

Silver - $3,500