Company Name*
Organization Type* Healthcare Provider Across the ContinuumHealth IT Vendor / DeveloperHealth Information NetworkPayer / Heath PlanConsumer / Data RequesterAssociationConsultantAccrediting Body / Standards Development OrganizationOther
Contact First Name*
Contact Last Name*
Contact Title*
Email*
Primary Contact Email*
Primary Contact First Name*
Primary Contact Last Name*
Secondary Contact Email*
Secondary Contact First Name*
Secondary Contact Last Name*
Company Address*
City*
State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip*
Phone*
Fax*
Web Page URL*
Accounting Contact Email* Please include a general organization email for billing and other related correspondence.
Select Membership Type to Calculate Annual Membership Fee* Government Nonprofit Healthcare Provider Corporate
Select Revenue/Budget and Full/Associate to Determine Fee* Federal - Full Member: $3,500Federal - Associate Member: $1,400State - Full Member: $2,500State - Associate Member: $1,000Local - Full Member: $1,500Local - Full Member: $600
Select Revenue/Budget and Full/Associate to Determine Fee* < $5 Million - Full Member: $3,500< $5 Million - Associate Member: $1,400$5 - 25 Million- Full Member: $7,750$5 - 25 Million - Associate Member: $3,100> $25 Million- Full Member: $12,000> $25 Million - Associate Member: $4,800
Select Revenue/Budget and Full/Associate to Determine Fee* < 100 hospital beds or <25 physicians / other providers - Full Member: $3,500< 100 hospital beds or <25 physicians / other providers - Associate Member: $1,400100-300 hospital beds or 25-75 physicians / other providers - Full Member: $7,750100-300 hospital beds or 25-75 physicians / other providers - Associate Member: $3,100> 300 hospital beds or > 75 physicians or other providers - Full Member: $12,000> 300 hospital beds or > 75 physicians or other providers - Associate Member: $4,8000
Select Revenue/Budget and Full/Associate to Determine Fee* <$5 Million - Full Member: $4,500<$5 Million - Associate Member: $1,800$5 – 24 Million - Full Member: $8,000$5 – 24 Million - Associate Member: $3,200$25-99 Million - Full Member: $13,000$25-99 Million - Associate Member: $5,200$100-499 Million - Full Member: $17,000$100-499 Million - Associate Member: $6,800>$500 Million - Full Member: $24,500>$500 Million - Associate Member: $9,800
I agree to receive electronic communications from The Sequoia Project.* Yes
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