Healthcare Membership Inquiry Form

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If you have reviewed the information about Schwartz Center membership and the Schwartz Rounds^® program on this website and are interested in learning more. Please Fill out the form below.

Name of Person to Contact*
First Last Suffix
Job Title*
Email Address*
Enter Email Confirm Email
Name of Hospital/Healthcare Institution*
Organization Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Website*
Phone*
Phone Extension
How do you classify your healthcare institution?*
Hospital Type
Long-Term Facility Type
Outpatient Facility Type
Other Type
If other, please specify:*
Is your institution a member of the Greater New York Hospital Association?*
- Yes
- No
- Not Sure
How did you hear about the Schwartz Center?*
Name of conference*
Name of Schwartz Center Event*
Colleague*
- Works within my organization
- Works at another organization
If other, please specify*
Additional Comments

617-724-4746 617-643-6123 info@theschwartzcenter.org

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