Corporate Membership Enrollment

Corporate Membership Enrollment
Submit your details below; your membership will be created and an invoice sent.

👉 Learn more about Corporate Member Levels and Benefits

Questions: corporate@urgentcareassociation.org

⚡️ Note: By completing this form and requesting a Corporate Membership invoice, you understand and agree to the UCA policy that membership dues are non-refundable.
Point of Contact Name*

First NameLast Name
Point of Contact Email*
example@example.com
Point of Contact Phone Number*
Please enter a valid phone number.
Company*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Website Address
Select your desired membership level:

Diamond ($30,000)Platinum ($18,000)Gold ($12,000)Silver ($6,000)Bronze ($3,000)Copper ($1,250)
*Rates subject to change. Please refer online to confirm current member rates.

📌 Enrollment for corporate memberships January 1 – September 30, are pro-rated for the current year. Enrollment October 1 – December 31, are pro-rated for the current year and include full payment for the following year.
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