MEMBERSHIP APPLICATION / RENEWAL

January 1, 2026 – December 31, 2025

PLEASE PRINT OR TYPE

INCOMPLETE APPLICATIONS WILL BE RETURNED

Please reference the enclosed Fact Sheets for the qualifications of each type of membership
Please complete the General Membership section AND all information under the specific area of membership for which you are applying.

GENERAL MEMBERSHIP INFORMATION

Name: Mr. o Ms.o Dr.o ___________________________________________________________________________

Nickname: _____________________________Department: ___________________________________ Title: _____________________________________


e-mail: __________________________________________________________________ o I do not have e-mail

Address: ____________________________________________________________________________

City: _________________________________________ State / Province: __________________________ Zip / Postal Code: ________________________

Telephone: (____)_________________ Fax:(____)____________________________

I do o do not o  have access to the Internet.

I have been a member of __________________________________________________for ______ years.
                                                 (name of predecessor user group)

ACTIVE MEMBERSHIP INFORMATION         FEE: $50.00

Hospital/Healthcare System: ________________________________________________ / _________________________________________

                        (Example: St. Vincent Hospital / Providence Health System)

Number of beds: ____________ / ______________________________

In the following section we ask that you indicate all Product Lines and Products you have installed AND in which you are interested:

Product Lines: oSTAR  oSeries  oPATHWAYS  oSAINT/Paragon  oPrecision  oTRENDSTAR  oCall Center  oSurgi/Omni  

Products:
o Access Management/ADT
o Clinical Documentation
o Contract Management
o Data Repository
o Data Warehouse
o Decision Support
o Document Management
o Electronic Commerce
o Finance (GL, AP, HR, Payroll)
 o Homecare
o Interface Engine
o Laboratory
o Managed Care
o Master Person Index (MPI)
o Materials Management
o Medical Records
o Order Management
o Patient Accounting
 o Pharmacy
o Physician Practice
o Physician Documentation
o Radiology
o Results Viewer
o Scheduling (patient)
oScheduling (staff)
oScheduling (surgical)
o Technology

oI DO NOT want to receive any unsolicited vendor information

Please see below for additional membership categories and general membership information

CONSULTANT MEMBERSHIP INFORMATION          FEE: $50.00

Employed By: _____________________________________________________________________________________________________

Sponsoring Hospital: ______________________________________________ Department: ______________________________________

(License Holder with Which you Currently Have a Contract to Provide Services)

Address of Sponsoring Hospital: ______________________________________________________________________________________

City: _________________________________________ State / Province: _______________________ Zip / Postal Code: _______________

Signature of Director of Above Named Hospital / Department: ______________________________________________________________

AFFILIATE MEMBERSHIP INFORMATION     ** FEES:  Partner $5000   Business $1500   Associate $750

Organization: ________________________________________________________________________________________________________

Description of your main business: ______________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Number of current HBOC sites where your software is currently installed or your services are currently rendered: ___________________

Do you have a current documented business partnership with a Corporate Partner Affiliate? ____________________________

If yes with whom? ____________________________

**After review and approval of your Affiliate Membership application you will be invoiced the appropriate dues for the Affiliate category for which you are approved. Invoices will be due and payable upon receipt and past due 30 days after the date of the invoice.

GENERAL MEMBERSHIP INFORMATION

oI haveohave not been issued a user name and password for the "Members Only" section of the InSight web page (http://www.insight-net.org)

By signing below I certify that I am eligible for the category of membership for which I am applying. I agree to abide by the bylaws and policies of InSight.


________________________________________________________ Date: _____________________________
Signature

Type of Credit Card (Please check one):

o American Express o MasterCard o Visa Cardholder Name: _____________________________________________________

Credit Card Number: _____________________________________________________________ Expiration Date: _______________________

Signature: _________________________________________________________________

For Active and Consultant applicants only:
Please make checks payable to InSight or complete the credit card information and mail with a completed application to:

InSight
4500 Hugh Howell Road
Suite 340
Tucker, GA 30084