Your email
Your name
Your Telephone Number
Are you interested in a free, no obligation quote for your organization’s broadband connectivity services? YesNo
Your Organization
Organization Type Non-Profit HospitalCommunity Health CenterHealth Department or AgencyCommunity Mental Health CenterRural Health ClinicDedicated Emergency Room of Rural FOR Profit HospitalSkilled Nursing FacilityEducational institution for healthcare instruction, (i.e., teaching hospitals or medical school)OTHER
Please select the type of organization that most closely resembles your organization from the list below. Non-ProfitPublicFor Profit
Organization Address (Street, City, NC, Zip Code & County)
If you'd like to check multiple sites eligibility, please include the additional addresses in an excel sheet or other compatible document and upload it here.
Would you like to receive email communication focused on broadband and connectivity access in the NC Healthcare Community from NCTNA? YesNo
