HSCA Connect Membership Application

HSCA is the trade association representing the Group Purchasing Organization (GPO) industry and is not a Group Purchasing Organization.

Company Name(Required)

Company Website(Required)

Upload company logo(Required)

Max. file size: 50 MB.

png, jpg

Social Media Links (Twitter, Facebook, LinkedIn)(Required)

Separate with a comma

Mailing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Physical Address (If different from above)

Street Address City State / Province / Region ZIP / Postal Code

Primary Rep:(Required)

First and Last Name

Title(Required)

Phone(Required)

Email(Required)

Seconary Rep:(Required)

First and Last Name

Title(Required)

Phone(Required)

Email(Required)

Type of Organization (check one)(Required)

Manufacturer

Wholesaler/Distributor

Software Provider

Consultant

Legal

Other (please specify)

Brief Company Profile and Primary Product Lines(Required)

Sales Volume(Required)

Please describe why you want to become a member of HSCA Connect(Required)

Please review the following statements and check if you agree(Required)

Are you willing to serve on an HSCA Connect committee?

Do you support the mission statement of HSCA Connect?

Payment of annual membership fees will be due upon approval of membership. Membership fees are $2,500 for organizations with sales under $50 million and $5,000 for organizations with sales over $50 million. All service providers will be assessed at $2,500 annually.