Join Now

We'd love to have you as a member here at NMBHPA! If you have any questions about our membership dues or questions about membership in general, please visit the Become a Member page. Otherwise, fill out the information below to begin the process of joining NMBHPA.

( * denotes required field )

Website Login Information

This information will allow you to login to the website later. You will be assigned a password that you can change at any later date. Once you've filled out this form, we'll send you an email with your new password and a login link.

Business Information

This information tells us who you are as a business. We promise not to share this information with anyone outside of our organization or sell it for any reason.

Representative Information

This information gives us all the data we will need in order to keep in contact with your chosen representative. We promise not to share this information with anyone outside of our organization or sell it for any reason.

Additional Information

Put any other emails you would like us to communicate with here. Please separate emails with a comma (e.g a@b.com, b@c.org)

In a few words, tell us why you are interested in becoming a member, and what you and your organization might contribute to our membership.

If your organization has been under any sanctions during the last 3 years, please describe the issues, the sanctions, and the status of any corrective action taken. If you've not had any sanctions in the last 3 years, please just enter 'None'.

Administrative Information

This gives us some idea of what you want out of your membership. These numbers are not necessarily final, but they give us a good idea of where to start.