IndianaPrimary Health CareAssociation
Home / IPHCA Members / Affiliate Application
To apply for a new Affiliate, Individual and Training membership, please complete the following application form.
For Primary Care Provider applications, click here.
As a condition of membership, contact information will be published in our membership directory and on the IPHCA website. Employee contact information may also be published in the membership directory, and/or on the IPHCA website.
A membership is not active until approval of the application by the IPHCA Board of Directors. Applicants will be notified by IPHCA within 6-8 weeks after submitting.
IPHCA reserves the right to reclassify a member to a different category when appropriate.
