Get Organizational Membership Application

Filling out the Organizational Membership Application online is a straightforward process. This guide aims to provide clear and detailed instructions to ensure a successful submission.

Follow the steps to complete your application with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin by entering the name of your organization in the designated field as prompted.
3. Fill in the executive director or CEO's name in the next field. Ensure this is the current individual holding the position.
4. Provide the complete address of your organization, including street address, city, county, state, zip code, and telephone number.
5. Indicate if your organization is urban or rural by checking the appropriate box in the applicant profile section.
6. For the funding base section, check all applicable options. If your organization receives Section 330 funding, be sure to include your UDS number and New Start/Start Date if relevant.
7. If applicable, attach your organization's bylaws to the application. This is mandatory for other organizations.
8. List key organizational staff and board members, providing their names, phone numbers, and email addresses.
9. Calculate your membership dues based on your organization’s total costs as reflected in your audited financial statements. Subtract 10% from the total cost before applying the dues assessment formula.
10. Select your preferred payment option for the membership dues. Complete the payment section with your credit card details if applicable.
11. Check the box if you wish to receive updates as a NACHC advocate.
12. Before submitting, ensure you have enclosed all necessary documents: payment details, list of health center officers, recent audited financial statements if applicable, and bylaws for other organizations.
13. After reviewing your application for accuracy, you may save changes, download, print, or share the completed form as required.

Start filling out your Organizational Membership Application online today to ensure your membership benefits are activated promptly.