KANSAS HEALTHCARE COALITIONS
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NOrth Central Kansas Healthcare Coalition
New Member REgistration
NCKS hcc New Member Registration Form
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Indicates required field
Agency Name
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Agency Type
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Select One
Hospital
Public Health
Emergency Management
EMS
Religious Non-Medical Healthcare
Ambulatory Surgical Center
Hospice
Psychiatric Residential Treatment Facility
All Inclusive Care for the Elderly
Transplant Center
Long Term Care
Immediate Care Facility for Individuals with Intellectual Disabilities
Home Health Agency
Comprehensive Outpatient Rehabilitation Facility
Critical Access Hospital
Clinic, Rehabilitation Agency, and Public Health Agency as Provider of Outpatient Physical Therapy and Speech Language Pathology Services
Community Mental Health Center
Organ Procurement Organization
Rural Health Clinic and Federally Qualified Health Center
End-Stage Renal Disease Facility
Private Partner
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State Partner
Federal Partner
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Choose the primary county your agency operates in.
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Last
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Agency Address
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Office Phone
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Fax Number
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Fax is still a viable redundant communication tool.
Mobile Phone
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Can you receive text messages on the mobile phone number you provided?
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Does your agency have access to an 800 MHz Radio?
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Unsure
Does your agency have access to WebEOC
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Does your agency have access to EMResource?
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Does your agency have access to eICS?
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Do you want access to member-only areas of our website?
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If you answer yes, please watch for an email with a unique website registration link for the website. Check your junk mail folder if you do not see an email.
How did you hear about our coalition?
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If you selected other, please list how you heard about our coalition
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Home
About
Conference
2022 Kansas Preparedness Summit
>
Conference Recordings
Home
Speakers
Agenda
Vendors
>
Vendor Sponsors
Vendor Registration
Conference Archive
>
2021 Kansas Preparedness Summit
>
Speakers
Agenda
Media
HCC-101
Calendar
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News
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