Registrant Information:
A valid email address is required for registration.
If you do not have one, visit: Yahoo or Gmail for a free account.

For basic security, please use your business information and do not include your private address or telephone number. Even though this information will not be shared with anyone, other registrants may be able to view your business information.

*Required Information  
*First Name:      
*Last Name:      
Are you a Provider?
Are you (or do you work for) an IHCP-enrolled provider?:     Yes    No
  *IHCP Provider ID:     
*Business Name:      
*Business Address:    
*ZIP Code:      
*Business Phone:      
*Confirm Email:      

Return to the Workshop Registration Main Menu -
Return to the main menu to access other IHCP workshop registration features.

If there are any questions, please call the IHCP Provider Workshop Line at (317) 488-5072. Calls will be returned within 2 business days.