Supporting Membership

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MNCM would like a few contacts from your organization to better target needed information, such as for billing and benefit access. We also plan in the future to create additional focus areas related to quality improvement and population health management.

Include a submember in your membership registration

Membership Level 1

Membership Level 2

Membership Level 3

Membership Level 4

Membership Level 5

I would like to automatically renew my membership

Secure Payment

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First Name *

Last Name *

Phone 1 *

Company Name *

Email *

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Secure Payment

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Primary Contact

This contact will be the primary contact for your organization and will be the main person to discuss anything related to this membership. including set up of the benchmarking report.

Primary Membership Contact Name *

Primary Membership Contact Email *

Primary Membership Contact Phone *

Primary Billing Contact

This individual will receive any information about payment processing and renewal invoicing, if applicable.

Primary Billing Contact Phone

Primary Billing Contact Name

Primary Billing Contact Email

Executive Level Contact

MNCM will occasionally reach out to this contact with higher-level information related to Health Care Data.

Executive Level Contact Name

Executive Level Contact Email

Executive Level Contact Phone

Informational Contacts

Who would be the best person in your organization to contact for these topics?

Population Health Management Contact Name

Population Health Management Contact Email

Quality Improvement Contact Name

Quality Improvement Contact Email

Secure Payment

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Include a submember

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Choose Existing Contact(s)

Membership Level *

I would like to automatically renew my membership

First Name *

Last Name *

Phone 1

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Add {{subMemberDisplayName}}

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

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Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

{{orderSummary.membershipOrderItem.cost==0?'Free':formatAmount(orderSummary.membershipOrderItem.cost)}} {{orderSummary.membershipOrderItem.termName}}

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Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

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{{sm.startDate}} - {{sm.endDate}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(sm.membershipInstallment.cost) }} until {{ sm.membershipInstallment.endDate }}

Membership auto-renews on {{sm.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(sm.membershipAutoRenew.cost)}}

Frequency selected: {{recurringUnitText}}. Next add-on payment processes on {{orderSummary.recurringDonationNextDate}} for {{formatAmount(orderSummary.donationAmount)}}

Discount Code

Code:

-{{formatAmount(orderSummary.codeDiscount)}}

Order summary

Subtotal {{formatAmount(orderSummary.subtotal)}}

Discounts -{{formatAmount(orderSummary.discounts)}}

Total {{formatAmount(orderSummary.total)}}

Secure Payment

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Card

ACH

Pay Later

or enter your card details below

Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card *

Billing address is the same as mailing address

Address Line 1

Address Line 2

City

State/Province

Zip *

Country

I will mail in a check or money order

Please mail your payment to:

3433 Broadway Street NE #455

Minneapolis , MN 55413

Amount:

{{formatAmount(totalAmount)}} USD

Secure Payment

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Supporting Membership Application

Membership level allows for a maximum of {{term.subMemberAllowed}} submembers.

	Contact Name	Membership Level
	{{item.contactName}}	{{item.membershipLevel==null?'-':item.membershipLevel}} {{item.startDate}} - {{item.endDate}}
No contacts.