Membership Application



Membership Class 

Please select one class of membership that best represents your request for membership:
Active Member: $350.00 $175.00
Associate Member: $150.00 $75.00
Affiliate Member: $350.00 $175.00

Applications received between January 1 April 30, (halfway into membership year), will be pro-rated 50% for the balance of the membership year (through June 30, 2017)

Increase the power of NRAA member benefits for your organization! Add additional contacts as members for just $50 and they receive full member benefits (with the exception of board of directors eligibility and voting privilege exclusive to primary contact). Click here Additional Contact Form to download the Additional contact join form.

Contact RPG GPO at 615-301-5960 to confirm your membership and request the discount code to apply to your NRAA dues.

NRAA GPO ID Code:

Company/Home Office Information
Company/Home Office Name:
Corporate Headquarters / Home Office Address:
City:
State:
Zip Code:
Phone:
Fax:
Website:
Member Company's Primary Provider Type (check one): Freestanding Dialysis Provider
Hospital Based Dialysis Provider
Management Consulting Company
Corporate


Organization Type (check one): LDO
MDO
SDO
Independent
Vendor/Partner/Consultant
Hospital Based
Number of Facilities:
Patients In Center:
Patients At Home:
 
Primary Representative Information
Must be designated by the Member Company and may be changed on written notice to the NRAA Board of Directors. Each member must designate one Primary Representative included with dues. Only the Primary Representative for an Active Member will be able to vote and is eligible to serve on the NRAA Board of Directors.
First Name:
Last Name:
Title:
  Check if same as company information above

Credentials:

Nursing License #:

CE/CME/Physician License #:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:
This application is for the 2016-2017 membership year (ends June 30, 2017).

Download & Print PDFs

Active/Affiliate Membership Application
Associate Membership Application
Additional Contact Form


Active Membership - $350 $175.00

An Active member of the association shall be a COMPANY that meets the NRAA definition of Provider Company or Management Consulting Company. An Active member company must designate a Primary Representative to represent it. An Active member may have unlimited non-voting NRAA Contacts that may participate in NRAA activities and benefits.

Additional Contacts = $50 per person

Increase the power of NRAA member benefits for your organization! Add additional contacts as members for just $50 and they receive full member benefits (with the exception of board of directors eligibility and voting privilege exclusive to primary contact). Click here Additional Contact Form to download the Additional contact join form.

Associate Membership = $150 $75.00

An Associate member is exclusively an INDIVIDUAL who is involved in the ESRD industry and supportive of the purposes of NRAA. These individuals are NOT directly employed by or otherwise involved in companies that are dialysis providers. These individuals are not eligible for membership as an Active member of NRAA.

Affiliate Membership = $350 $175.00

An Affiliate member is any COMPANY involved in the ESRD industry and supportive of the purposes of NRAA. These companies are not eligible for membership as an Active member of NRAA. An Affiliate member may have unlimited NRAA Contacts that may participate

Additional Contacts = $50 per person

Increase the power of NRAA member benefits for your organization! Add additional contacts as members for just $50 and they receive full member benefits (with the exception of board of directors eligibility and voting privilege exclusive to primary contact). Click here Additional Contact Form to download the Additional contact join form.