Join CARHC

If you have any questions, email to Info@CARHC.org or call 916-865-1897.

NARHC Member Clinic: Join at www.NARHC.org - Price is $600
(for information on NARHC membership,
visit www.NARHC.org or call 866/308-1961)
Non-NARHC Member Clinic: $600
Affiliates (Non-Clinic Member): $200

Non-NARHC Member Clinics and Affiliates continue below.
NARHC Member Clinics please go to
www.NARHC.org.

Organization Information (to be displayed online)
Organization Name *
Clinic Name (if applicable)
Address 1 *
Address 2
City *
State *
ZIP Code *
County *
Phone *
Fax
Website
Clinic Email *
Annual RHC Encounters *
RHC Certification Year *
# of RHC Employees *  
RHC Category *
Ownership Category *
Main Contact
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Title
Phone *
Email *
Member Name(s) and emails: (We encourage multiple contacts in your organization.)
Billing Address (if different)
Street
City
State
Zip
Mailing Address (if different)
Street
City
State
Zip
County
Additional Information
Referred by
How did you hear about us?
What is your reason for joining?
Please have someone contact me regarding
*Check all that apply
Business Resources
Community Involvement
Cost Savings Programs
(Insurance, Office Supplies, Worker's Compensation)
Economic Development
Government Relations
Networking
Other           
Membership Investment
Membership Category: *
Primary Directory Category *
Additional Directory Categories
  • Primary Directory listing is complimentary
  • Up to two additional Directory listings are complimentary
  • After two, additional Directory listings are $35 each
**Hold CTRL on your keyboard to select multiple categories**
   
$ 
Total: $ 

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Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
Revenue Item
tempValueForDropDown1
Number of Full Time Employees:
Number of Part Time Employees:  
Number of Rooms (Accommodations):  
Number of Seats (Restaurants):  
Number of Associates (Realtors, Attorneys):  
Number of Locations ($35/add. location):  
Millions in Assets (Financial Institutions):  
Enhanced Membership ($50):
$ 
$ 
*
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Credit Card Information
Credit Card Type *
Credit Card Number * 
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Credit Card Email Address
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