Clone of NCHIA Spring 2026 Registration

NCHIA Fall 2026 Registration

NOTICE: Agencies will receive notification if their enrolled employee does not successfully complete a training course or event.
Please fill out all blanks on this form and check your answers for accuracy. Failure to provide the information requested may result in the inability of our registrar to provide you with a complete training transcript.
How did you hear about us?

Other
Attendee's Name

First NameMiddle NameLast Name
Attendee's Social Security Number (Please insert last 4 numbers)
Attendee's Date of Birth

MonthDayYear
Agency
Employing Agency Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Attendee's Phone Number

Area CodePhone Number
Attendee's E-mail

Confirmation Emailexample@example.com. The phone number and email provided will be utilized by NCHIA for current and future conference events. The email will be provided to vendors.
Attendee's Job Title
Conference
Agency Type
Payment Options
Pay at Conference: $350.00 for new or returning members or $70 per day for each day attended if you do not stay the entire week. The fee includes your $20.00 yearly membership dues.
1. Mail Check to NCHIA, PO Box 425 Newport, NC 28570- $350.00 for new or returning members. The fee includes your $20.00 yearly membership dues.

USDDescription

NCHIA Fall 2026 Registration