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IAHHC Sign Up Information

Last Updated:

2/17/2020

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Email Address

Your Name

First Name, Last Name

Your Address

Phone Number

Phone

Post-Registration Data

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Membership Emails

Below is a sample of the emails you can expect to receive when signed up to IAHHC.

IAHHC Contct form Dated Februa...

Mr. Wright,

I am following up on the contact us form that you submitted?on February 21, 2020 indicating you request to be added to membership committees.

A review?of our membership database and online applications for membership do not reflect anything for you or your company.

If I have missed any request to process membership, please advise so that I can provide you with membership information. We have Voting/Home Health Hospice, Voting Personal Services Agency and Associate Vendor Memberships.? Please advise of your interest so that I may provide you with the relevant information.

Please feel free to reach out to me at (317) 775-6672 or michelle@iahhc.org.? Have a nice day.

---------- Forwarded message ---------
From:?<no-reply@editmysite.com>
Date: Fri, Feb 21, 2020 at 7:31 AM
Subject: New Form Entry: Contact Form
To: <tori@iahhc.org>

You've just received a new submission to your?Contact Form.
Mark as Spam

Submitted Information:

First Name
Ethan

Last Name
Wright

Company Name
Jon

Select Committees.Education Committee
1

Select Committees.Home Health Committee
1

Select Committees.Hospice Committee
1

Select Committees.Hospice Bereavement Networking Group
1

Select Committees.Hospice Chaplain Networking Group
1

Select Committees.Hospice Social Worker Networking Group
1

Select Committees.Hospice Volunteer Coordinator Networking Group
1

Select Committees.PSA Committee
1

Select Committees.Reimbursement Committee
1

Phone Number
07995649337

Email
@

Electronic Signature
Jon

Michelle Stein-Ord??ez

Membership Services Director

Indiana Association for Home and Hospice Care

6320G Rucker Road

Indianapolis, IN? 46220

P:? (317) 775-6672

F:? (317) 775-6674?

Save the dates for the 2020 IAHHC Annual Conference!

Wednesday, May 6th?& Thursday, May 7th,?2020

Embassy Suites?- 6089 Clarks Creek Rd, Plainfield, IN 46168

DISCLAIMER

Any advice or comments provided by an employee of the Indiana Association for Home and Hospice Care, Inc., (IAHHC) is provided with the understanding that neither the employee nor IAHHC is rendering legal or accounting advice or other professional service. In all cases, if and when legal, accounting or other professional service is required, the services of a competent professional person should be sought.
CONFIDENTIALITY NOTICE
This e-mail, including any attachments or files transmitted with it, is intended to be confidential and solely for the use of the individual or entity to whom they are addressed. If you received it in error, or if you are not the intended recipient(s), please notify the sender by reply e-mail and destroy all copies of the original message and any attachments. Any unauthorized review, use, disclosure or distribution of this e-mail or information to anyone, including non-members of IAHHC and government agencies, is prohibited and may be a violation of HIPAA or other law and may result in legal action.

Raw Data Registration Structure Registration Form Text

Registration

Company Name *

First name

Last name

Phone

Select Committees *

Education Committee

Home Health Committee

Hospice Committee

Hospice Bereavement Networking Group

Hospice Chaplain Networking Group

Hospice Social Worker Networking Group

Hospice Volunteer Coordinator Networking Group

PSA Committee

Data Name	Data Type	Options
Company Name *	Text Box
First name	Text Box
Last name	Text Box
Email	Text Box
Phone	Text Box
	checklist	Select Committees *
	checklist	Education Committee
	checklist	Home Health Committee
	checklist	Hospice Committee
	checklist	Hospice Bereavement Networking Group
	checklist	Hospice Chaplain Networking Group
	checklist	Hospice Social Worker Networking Group
	checklist	Hospice Volunteer Coordinator Networking Group
	checklist	PSA Committee

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Comment on: 01/09/2020