Member Application

Member Application

"Where everyone has a seat at the table"
Name *

First Name Last Name
Email *
example@example.com
Additional Contact Emails for Organization
Organization/Business
Position In Organization
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Please Upload your logo for our website

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PLEASE ANSWER THE FOLLOWING QUESTIONS
How did you hear about HCN *
What do you hope to gain from HCN *
Tell us about your professional and educational background and goals
Which HCN Action Teams are you a part of or interested in joining:

Health Access Educational Equity Family Empowerment Workforce Development
2021 ANNUAL BENEFITS & DUES
Membership Type:
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Student Membership $ 25.00

Individual Membership $ 50.00

Non Profit Membership $ 100.00

Small Business Membership $ 150.00

Corporate Membership $ 200.00

Total $ 0.00
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Thank you for becoming an HCN Member, we are excited to have you as part of our collaboration with the mission to cultivate a diverse community that has access to culturally enhanced services which results in improved quality of life and access to opportunity for every person to reach their full potential and succeed.

We accomplish this with the vision to mobalize individuals and organizations to collaborate through educating, advocating, and reducing cultural and linguistic barriers.

We look forward to serving you and your organization as part of our diverse membership and we are here to support you in your success.
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