NCHA Affiliate Member Application
Business Type - Affiliate
Shared Services Organization
Educational Institution without medical/nursing programs
Funder or Foundation
Government Agency not providing direct care
Other (please specify below)
If you selected "other' above, please specify your type of business
Address line 1
Address line 2
CEO phone number
CEO Executive Assistant
Executive Assistant phone
Executive Assistant Email
CEO or Executive Letter
In order for your membership application to be processed, the CEO or Executive of your organization must submit a letter to Steve Lawler, President of the North Carolina Healthcare Association (NCHA) officially requesting membership. The letter should explain your organization’s alignment with the mission, values and objectives of NCHA. The membership application and letter will be presented to the NCHA Board of Trustees for review and approval. The NCHA Board retains the right to approve or deny any application at its discretion.
Affiliate Member dues are $10,000. Dues are payable annually by January 1. Memberships that are approved after the start of the calendar year will be eligible for pro-rated dues.
If you have any questions regarding this application or the status of your membership request, please contact Tatyana Kelly, Vice President of Member Services, at 919-677-4253/ firstname.lastname@example.org.
Upload CEO letter here
Send me a copy of my responses
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