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 Membership Application

There are several categories of Leapfrog membership:

- Leapfrog Partners are companies who have more than 25% of their revenues from the health care industry. Annual dues are $25,000.

- Leapfrog Members are companies who have less than 25% of their revenues from the health care industry. Annual dues are based on the type of organization:

  • Non-profit businesses and public payers can become members for $4,000
  • For-profit businesses who with current membership in a local or regional Business Coalition on Health [linked] can become members for $4,900
  • For-profit businesses can become members for $10,000

- Professional Members are individuals who would like to apply to join Leapfrog as a sole beneficiary; dues are $499/year.

Section A: Membership Type
Section B: Organization Information

Organization/Name

 Phone #

Address

 Email

City, State

 ,  # of covered lives

Zip Code

    

Section C: Primary Contact
Name Direct Phone #
Title Email
Street Address    
City, State ,     
Zip Code    
Section D: Billing/Accounts Payable (if different from above)
Attn Direct Phone #
Title Email
Street Address    
City, State ,    
Zip Code