Join the NEAHC - Northeast Arkansas Healthcare Coalition

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> Coalition Toolbox

> Home
> About Us
> Calendar
> Contact Us
> Join NEAHC
> Resources
> Coalition Toolbox

If you would like to join and support the Northeast Arkansas Healthcare Coalition, please submit your information using the form below, and a membership representative will contact you as soon as possible.

Arkansas Healthcare Preparedness Coalition Membership Application Region: Northeast

Organization Legal Name: *

Physical Address: *

Facility Main Phone Number: *

Fax:

E-mail *

Voting Member Point of Contact: (person that attends meetings on a regular basis) *

Cell Phone#: *

Non-Voting Member Point of Contact:

Does your facility have or use AWIN?

Does your facility have or use Internal Radios?

Does your facility have sattalite phone? If so, what is the number and how many active Min.

Does your facility have or use Ham Radio?

If so, what is your Call Sign and Name:

Alternate Care Site location.

Please select the checkbox below to prove that you are a human. *

Fields marked with * are required.

Jonesboro Arkansas

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870-240-0922

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