NYS CCBH Affiliate Membership Application
Affiliate Membership with NYS CCBH includes for-profit supplier organizations to the children's behavioral health sector such as technology, consultants, insurance, finance, and other businesses that desire to support the work and further the mission of CCBH.

Dues are $5,000 annually.

Please direct all questions to info@ccbhny.org.
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Company Contact Information
An invoice for annual membership dues will be sent to the physical and email address included below.
Company Name *
Briefly share information about the product or service your company provides. *
Main Contact Full Name *
Main Contact Title *
Main Contact Email Address *
Billing Address *
Please include street address, city, state and zip code.
Phone Number *
Company Web Address (if applicable)
I understand that an invoice for our annual dues of $5,000 will be sent to the physical and email addresses included above. Membership benefits will begin upon receipt of payment.
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