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* Mandatory fields
*First name
*Last name
Organization
*Street Address
*City, State, Zip
*Email
We strongly encourage you to use your personal email as your primary as many hospitals block external emails. This would prevent you from getting our communications!
Secondary Email
Add a secondary email, in the event you are using a work email and you changed jobs so we can maintain contact with you.
Professional Certification
Professional Certification (Other)
Education Degree / License level
Discipline
This is important to help us make sure the education and resources we are providing is applicable to all of our
Discipline (Other)
If you selected other, please tell us what field you are in so we can include it in our events, education and resources.
Would you be interested in leadership/committee role?
Members engaging in our organization are what makes it so amazing. Would you be interested in participating in leadership or committee roles?
How did you hear about us?
Were you referred by a Member? If so, fill in their name.
Our referral program will extend a member's membership by 1 month for each referral they send our way. Please be sure to give them credit as a thank you for sharing TGCAHQ with you!! Then you can pay it forward and get free months for you!
Referrals
We love referrals!!
*Amount ($USD)
 Payment frequency
Comment
 



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TGCAHQ is a 501(c)3 non-profit organization.
Houston, Texas
 

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