New Group Member Application

Instructions

Use this form for a NEW Group Membership application in NHIMA.

• Please fill in all required fields.

• Your “Contact Person” will receive all publications, membership renewal information, and general correspondence from NHIMA for this group membership.

• When your form is completed, hit the submit button to go to the payment section. All payments are in US dollars because NHIMA is a US based non-profit organization. We are sorry if this causes any inconvenience. 

• If you choose to pay by credit card you will receive an email of your membership approval within 24 hours.  This will include a membership card and instructions on how to login to your profile and Members Only access area of the website. We accept VISA, Mastercard, American Express and Discover. 

• If you wish to pay by check (USD Funds) you can bypass the payment option and will receive an email with your balance due.  Please send a check (payable to NHIMA) to:
  NHIMA, 2565 Brighton Henrietta Town Line Rd, Rochester, NY 14623, USA
  Your membership will be approved upon receipt of payment and you will receive an email with instructions on how to login to your profile and access the Members Only access area of the website.

Contact Information

YOUR GROUP'S NHIMA WEBSITE LISTING

The information below is used to create your group's NHIMA website listing. All fields are required but you may use TBD or N/A if there is a field for which you do not currently have information or that does not apply.