2021 Membership Dues Renewal & Assessment
NCHN was formed by members to support their networks. Thank you for your 2021 renewal. It ensures your continued connection to peers across the country, access to the latest news related to health networks, educational opportunities, the latest federal funding opportunities, and other benefits designed to support you and your network. We look forward to working with you in 2021 and appreciate your continued support.

2021 membership runs from May 1, 2021 - April 30, 2022.

This dues assessment form should be completed by April 10, 2021.

2021 dues are expected to be paid by April 26, 2021.
  • Enter the TOTAL AMOUNT ($) of the network’s most recently reported Operating Expenses, as reported on the network’s 990 form and/or other Internal Revenue Service reporting format, including expenditures for all programs & services, including programs supported by grant funds, and any additional companies that are under the management of the parent organization. NCHN Membership dues are based on your reported operating expenses.

    Less than $250,000 = $650
    $250, 001 - $500,000 = $950
    $500,001 - $750,000 = $1,250
    $750,001 - $1,000,000 = $1,550
    $1,000,001 - $5,000,000 = $1,850
    over $5,000,000 = $2,150
  • If your network does not have a website, please enter "none".
  • Please enter the email address where you would like us to email your dues invoice.

    After we receive your renewal form, we will email an electronic invoice for your dues via PayPal. From that invoice you will be able to pay your dues with a credit card electronically. If you prefer to pay by check, you may do so. If paying by check, please mail it to:
    NCHN
    c/o Linda Weiss
    231 NW 53rd Street
    Oakland Park, FL 33309
  • NCHN is an organizational membership organization. The network organization is the member of NCHN; however, a contact person for each network must be designated each year to be the official contact for NCHN membership information. Please indicate in the box above, the name of the network’s official representative for 2021. This is the person of record that will receive official NCHN notifications, updates, and other information throughout the year. Please note that the network leader serves as the NCHN official contact for the majority of our members; however, another full-time staff member can be designated the contact by the network leader if desired.

  • Your Network Information

    We constantly strive to maintain up to date information on our member networks. This information is utilized to assist committees in understanding your needs and to assist collaboration among members. We know that your membership composition and programs change periodically. Please take a moment to complete the information below, so we can keep our membership records up to date.
  • Total # of Members
    Ambulance Providers
    Behavioral Health Providers
    Community-Based Organizations
    Community Health Centers
    Critical Access Hospitals (CAH's)
    Free Clinics
    Hospice Agencies
    Hospital-Owned Provider Clinics
    Large Hospitals (>200 beds)
    Long Term Care Facilities
    Medium Hospitals (50-200 beds)
    Oral Health Providers
    Physician Owned Clinics
    Post-Secondary Educational Institutions
    Public Health Departments
    Rural Health Clinics
    Schools/School Districts
    Small Hospitlas (<50 beds)
    Surgical Center
    Other *