Become A Partner

Please fill out the form below to signup
for membership.

Dues are paid annually based on the day you join.

Account Creation

Create a Username and secure Password.

Username requirement:
  • Must be 6-24 characters in length.
Password requirements:
  • Must be 6-24 characters in length.
  • Must contain atleast one uppercase letter.
  • Must contain atleast one non alphanumeric character. Example: * _ + $ @
Member Information

Company Information

Are you licensed in the Commonwealth of Virginia?
Company Social
Company Location
Step 1: Go to https://maps.google.com.
Step 2: Search google maps for the correct location.
Step 3: Copy the link in the URL bar and paste it in the input box above.  

Contact Information

Primary Contact
Secondary Contact

Company Overview

Please provide detailed information about your organization. You may type (or copy & paste) information into the box below.

Company Overview is what the public will read about your organization (and search engines too). Tips: Use strategic keywords that are specific. Incorporate words and phrases for services that your customer will be searching to find you.

Information may include: Intro, Mission, History, Services, Call to Action, Who, What, When, Why, etc.

Service Areas

Central Virginia

Please select all service areas where your company provides service in Central Virginia. These service areas are free of charge.
Areas
Selected Service Areas

Outside of Central Virginia

(Optional) Select the service areas/cities where your company provides service outside of Central Virginia. Each service area is $50.00.
State
City
Selected Service Areas

Related Categories

Select one or two categories below. Be sure you are listing your organization properly. You must select at least one Service for each Category you select.

Services will appear after Category selection is made below. These two categories slots are free.
Category 1 *
Category 2
No category selected
No category selected

Additonal Categories

(Optional) Select additional categories related to your organization. Each additional category is $100.00.
Add another category

Enhance Your Listing

What do you get with an Enhanced Listing?

  • Inclusion on the rotating banner ad on our home page.
  • Company logo at the top of one directory category.
  • Highlighted Directory Listing, moved to the top of the category's listings. First come first served basis. If you're the first in your category to enhance your listing, you will be listed first!
  • Easy access by Web site visitors to your company overview, products, services, and more.

What is the cost?

$225.00 Membership per Period (12 Months from date when payment is confirmed and account is activated).

Member Agreements

Individual Networking Agreement
HCA Hospitals Vendor Visitation Policy
Policy and Procedures
  • Partners must pay for luncheons no less than one week in advance of luncheon date. If a Partner cannot keep the scheduled dated listed on the lunch rotation list, they are responsible for their portion of payment unless a Partner from the will-call list can fill that spot.
  • Partners must be accountable for your Partnership participation just as you would for your individual businesses.
Mailing Address
Please mail all agreements that require a signature to:
Partners in Healthcare of Virginia
Attn: Membership
P.O. Box 29604
Richmond, VA 23242

Application Summary

Please verify that all sections are complete and contain valid information before submitting your application.
Account Creation
Member Information
Company Information
Company Social
Company Location
Primary Contact
Secondary Contact
Company Overview
Service Areas
Related Categories
Enhanced Listing
Member Agreements
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Format: MM/YY or MM/YYYY
i.e. Bank of America
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9 digits
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by pressing the submit button.
Please mail a check in the amount of price unavailable to:

Partners in Healthcare of Virginia
Attn: Membership
P.O. Box 29604
Richmond, VA 23242


Important: In the Memo/For section of your check, please write: .

After we have received your check, you will be notified and your account will be updated with the items you've purchased.