Thank you for your interest in serving and partnering with Minnesota's community health centers. 
 
At the end of this application, you will be prompted to pay the $175 application fee electronically by credit card or by mailing a check. 
 
Contact: 
Shelby Maidl
Program Specialist
Minnesota Association of Community Health Centers
shelby.maidl@mnachc.org

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* 1. Company Name

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* 2. Company Website

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* 3. Contact Person Name

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* 4. Contact Person Title

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* 5. Contact Person Email

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* 6. Contact Person Phone

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