Membership Application

  • To apply for membership in the Michigan Trauma Coalition, please fill out the form below. Once we receive your application, we will send you an invoice. Required fields are marked with an asterisk (*).

  • The hospital name you enter here should be the official name of your institution, not a nickname.
  • This must be a street address so that the Member Map can show your location accurately.
  • Dues: $3,500/year for Level I and Level II trauma centers, $1,000/year fpr Level III trauma centers, and $500/year for Level IV trauma centers.

  • This is the person who will receive the MTC Membership INVOICE and each year's renewal.

  • Your Hospital/Trauma Center Personnel

    Individuals below will have access to the "Members-Only" sections of the MTC website.

  • This field is for validation purposes and should be left unchanged.