Make a Payment

Name: Novant Vendor Fair
Start: 2021-04-22T09:00:00-04:00
End: 2021-04-22T09:00:00-04:00
Location: Forsyth Medical Center, Conference Center

Need to make a one-off or special payment for something other than Membership Dues or one of our events? You can use this form.

Name*
First Last
Organization/Company*
Email*
Phone*
Reason for Payment*
Please indicate the reason for this payment. If you are trying to pay HIPSS Membership Dues, please visit the Annual Dues page.
Details*
Please provide any details necessary to ensure your payment is credited and applied properly.

Enter Your One-Time Payment Amount*
Amount To Be Processed
$0.00
Credit Card*

Card Details

Cardholder Name
Address*
Street Address Address Line 2 City State ZIP Code