Application Form


The North Carolina Healthcare Information and Communications Alliance, Inc. (“NCHICA”) is a 501(c)(3) nonprofit corporation. Membership is open to any healthcare provider, persons providing services to healthcare providers, governmental entities, educational or scientific research organizations, and other non-governmental entities serving the healthcare industry. Membership, unless otherwise provided by the Board of Directors, will be required for participation in any of the activities sponsored by NCHICA. Applicants are accepted for membership upon submission of this application, payment of the annual dues for the first year of membership, and acceptance of this application by NCHICA. By submitting this application, the prospective member agrees to the Terms of Membership attached to this application.

Before completing this application, CLICK HERE to confirm your organization is not already a member of NCHICA. If your organization is an NCHICA member and you wish to apply under that membership, CLICK HERE.


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Primary Representative

Alternate Representative

Membership & Dues