Communities Champion Membership

An Individual, Organization, or Center who takes a lead role as organizer of the Community of Practice and runs/hosts a structured program of activities and events and is responsible for generating thought leadership content on the chosen topic.

Name:

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Offline Payment

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Pay NC Health Innovation District

$100 / Month

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Terms: $100 / Month

	Communities Champion Membership – Initial Payment $100 / Month	$100.00
	Total	$100.00

Communities Champion Membership – Initial Payment

$100 / Month

$100.00

Total

$100.00