Membership Application

For Members > 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

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