Membership Application

Step 1. Select Your Organization's Type or Category...

Determine your organization's type below by clicking the button beside the membership category that most closely fits your organization. After making your selection, click NEXT to go to Step 2.

Enter your organization's name as you would like it to appear in our membership directory:
(You must provide a name to continue. Use "Self" for Individual or Student membership applications.)

Corporate Corporations, partnerships, and other for-profit entities. (Dues are based on annual corporate revenues from healthcare-related business)

	Revenues of $500,000,000+ Annual dues: $10,000
	Revenues of $25,000,000 - $499,999,999 Annual dues: $5,000
	Revenues of $5,000,000 - $24,999,999 Annual dues: $1,000
	Revenues of $1,000,000 - $4,999,999 Annual dues: $500
	Revenues of less than $1,000,000 Annual dues: $250

Individual Individuals who wish to support NCHICA or who wish to be kept directly informed of NCHICA activities. Individuals in this membership category are non-voting members.

	Individual not employed by an organization eligible for membership in any other category (i.e. retiree or not currently employed) Annual dues: $250
	Individual affiliated with and sponsored by a professional association that is a member of NCHICA Annual dues: $95

Medical and Dental Practices Enterprises with physicians, dentists or other medically trained personnel that provide direct medical services and/or managed care services to patients

	Professional organization/clinic with more than 25 physicians and/or other providers Annual dues: $1,000
	Practice or clinic with 11 - 24 physicians and/or other providers Annual dues: $500
	Practice or office with 10 or fewer physicians and/or other providers Annual dues: $250

Nonprofit Nonprofit professional, charitable, scientific or educational organization that qualifies under section 501(c) of the Internal Revenue Code (not including Providers as defined above).

	Gross revenues/budgets of $5,000,000+ Annual dues: $1,000
	Gross revenues/budgets of $1,000,000 - $4,999,999 Annual dues: $500
	Gross revenues/budgets of less than $1,000,000 Annual dues: $250

Provider (Other than physicians and dentists) Enterprises with medically trained personnel that provide direct medical services and/or managed care services to patients

	Academic Medical Center and related teaching hospital(s) and clinic(s); or a hospital / hospital system with 401+ licensed beds, or; a managed care organization Annual dues: $5,000
	Hospital with 251 - 400 licensed beds Annual dues: $1,000
	Hospital with 100 - 250 licensed beds Annual dues: $500
	Hospital with fewer than 100 licensed beds Annual dues: $250

Public Agency Federal, State, city, county agency or special governmental district (not including Providers as defined above)

Annual dues: $250

Student Full-time student at an accredited institution of higher learning. Individuals in this membership category are non-voting members.

Annual dues: $25