IHCA/INCAL Associate Membership Application

Your Name

First Last

Your Email

Your Phone Number

Company Name

Address

Street Address Address Line 2 City State Zip Code

Phone

Website

Key Staff Information

IHCA/INCAL offers a wealth of resources that are exclusively developed for our members. To maximize your membership benefits, it is important that you provide us with the contact information of key staff members of your facility who should receive access to IHCA/INCAL's suite of digital communications resources including a self-serve member portal, e-newsletters, toolkits, on-demand education offerings, and more. Please use the "plus sign" on each field to add a row to input additional contacts.

Please use the "plus sign" on each field to add a row to input additional contacts.

First Name

Last Name

Title/Designation

Email Address

2023 Associate Member Dues

Dues for Associate Membership are collected on an annual basis and provide Associate Members benefits from the date of membership approval by the IHCA Board of Directors to December 31, 2021. Please be advised that pursuant to Federal tax law dues spent on lobbying and other related costs are not deductible for federal income tax purposes. The IHCA/INCAL reasonably estimates that 10% of dues will be spent on lobbying costs for 2022.

Please Select Your Membership Level

Please contact Colin Hebenstreit at chebenstreit@ihca.org regarding availability of Title membership*.

Standard Member - $750

Key Member - $2,500

Title Member* - $12,500

Agreement and Payment

I agree to the privacy policy.

I understand that submission of this application is not a guarantee of IHCA membership and that this application must be approved by the IHCA Board of Directors. Approval of membership does not constitute endorsement by the IHCA of applicant or its products and/or services. I understand that membership benefits are only to be used by the applicant and its employees and that any misuse of membership rights and benefits may result in membership termination. If this application is approved, IHCA may use applicant’s information in IHCA electronic membership directory, and applicant consents to receive communications via regular mail, email, telephone, and/or fax sent by or on behalf of IHCA. Payment of 2023 Associate Member Dues must accompany this application and will be processed upon receipt. Payment will be refunded if membership is denied.

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Associate Membership Application