2023 Membership Renewal Ivy Tech

You will receive an email invoice. You may also opt to have an invoice sent directly to a finance department and/or assistant
The invoice contains complete payment instructions. Payment is accepted by check, ACH, or credit card
Credit card payment will include an ADDITIONAL PROCESSING FEE: 1.99% of membership fees plus $0.49

Organization Name*
Do you have a PO #*
- Yes
- No
ICN 2023 Membership Fees for ITCC Nursing Program Campuses/Sites: 1.ITCC Statewide Nursing (Jewel Diller) 2.Fort Wayne 3.Indianapolis 4.Lafayette 5.Madison/Lawrenceburg 6.South Bend 7.Valparaiso 8.Sellersburg 9.Richmond
Price:
Hidden
# of schools
Total
$0.00
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Enter Email Confirm Email
Phone*
Do you want an invoice sent directly to accounts payable/finance department?*
- yes
- no
Accounts Payable/Finance Dept. Representative Name
First Last
Accounts Payable/Finance Dept Email
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e-signature*

This electronic signature attests to the accuracy of the information above

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