Get Chen Membership Application - Bchenb Bnwlab - Chen-nwla

Filling out the CHEN Membership Application is a straightforward process that allows you to become part of the Community Healthcare Education Network of Northwest Louisiana. This guide provides clear, step-by-step instructions to assist you in completing the application online efficiently.

Follow the steps to complete the application successfully.

1. Use the 'Get Form' button to access the application form and open it in your preferred editor.
2. Begin by filling out the applicant information section. Enter the membership name, which can be your company, employer, or yourself. Then, provide your complete address, including city, state, and zip code.
3. In the membership category section, select only one option that applies to you by checking the corresponding box: Network Membership, Associate Membership, or Honorary Membership.
4. Fill out the representative information. Start with Representative #1, which is required for all memberships. Provide their name, address, position, city, state, zip code, phone, fax, cell, and email.
5. If you are applying for Network Membership, proceed to fill out the Representative #2 information. This section mirrors the previous one, requiring similar details for the second representative.
6. Next, address the membership criteria by checking all applicable options that describe your organization. You can select from categories such as Assisted Living, Hospice, Nursing Home, and others listed.
7. In the signatures section, authorize the verification of the information provided by signing and dating the form. If applicable, have the second representative sign and date as well.
8. Finally, review all entered information for accuracy. Once you have confirmed that everything is correct, save your changes. You may then choose to download, print, or share the completed form as necessary.

Complete your CHEN Membership Application online today to join a vital network supporting community healthcare.