Membership Application


Click a link below to download the DVHCC Membership Application in one of the following formats:

DVHCC Membership Application Microsoft Word 

DVHCC Membership Application PDF

Please complete as thoroughly as possible and submit via e-mail, fax, or mail to our office at

2980 SOUTHAMPTON ROAD,  PHILADELPHIA, PA 19154   

Fax: 215-676-7941    

E-mailinfo@dvhcc.org

All applications for membership and renewal of membership are subject to approval by the DVHCC Board of Directors andcontingent upon receipt of a check for Seven Hundred Fifty ($750.00) dollars representing:

  • the one-time initiation fee of Five Hundred ($500.00) dollars 
  • the first year’s annual dues of Two Hundred Fifty ($250.00) dollars 

Please make your check payable to the Delaware Valley Health Care Coalition, Inc.

Visit our Frequently Asked Questions page or contact our office with any questions or concerns.