Affiliate Application - Indiana Primary Health Care Association

New Affiliate, Individual and Training Application

To apply for a new Affiliate, Individual and Training membership, please complete the following application form.
For Primary Care Provider applications, click here.
Membership type*
Please select one. For full details of IPHCA membership types, please click here.
- Affiliate
  $500.00
  Affiliate Membership is available to any non-profit organization that provides services or conducts business to improve access to primary care services for Indiana residents that is not a community health center and does not offer primary care services.
- Individual
  Training
  $100.00
  Individual / Training Membership is open to any person supporting this Association’s purposes, including students, residents, or others training in the health care field.