Join Now(가입)

  • Application for Membership

  • Sponsor Group – CHMAN (크리스천 헬스케어 한인지원센터)
  • *Indicates a Required Field
    • Applicant Information

      • First Name*
      • Last Name*
      • Middle Initial
      • Gender*
      • SSN #
      • Date of Birth*
      • Address*
      • Address2
      • City*
      • State*
      •  
      •  
      • Zip*
      • Primary Phone*
      • Work Phone
      • Cell Phone
      • Email*
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      • Confirm Email*
      • Participation Level
      • Add Brother's Keeper:
        Membership increases your maximum sharing amount.
      • Qualify for Medicare
      • Medicare A and B
    • Spouse Information (if applicable) (참여하는 배우자 정보)

      • First Name
      • Last Name
      • Middle Initial
      • Gender
      • SSN #
      • Date of Birth
      • Participation Level
      • Add Brother's Keeper
      • Qualify for Medicare
      • Medicare A and B
    • Dependent Information (if applicable) (참여하는 자녀들 정보)

      • First Name
      • Last Name
      • Middle Initial
      • Date of Birth
      • Gender
      • SSN #
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      •  
      • Join Now
      • If 18 years or older, please select all that apply:
      • My adult child is 25 years old or younger.
      • My adult child is a Christian living by biblical principles.
      • My adult child is not married.
      • My adult child is reported as a dependent on my income tax forms.
      • Participation Level for all dependents
        What does this mean?
      • Add Brother's Keeper
    • Previous Condition Information (if applicable) (지병에 관하여)

    • Please include information about all conditions for which you have experienced signs, symptoms, or treatment within the past five years. Your membership in Christian Healthcare Ministries will not be denied based on the information you provide. The information will, however, help us determine if we can assist you through one of our programs for pre-existing conditions. To learn more, click here.
      (증상을 포함한 지병에 관해 설명해 주세요. 이 내용때문에 가입을 거부당하지 않습니다. 지병에 관한 제한적 지원여부는 가이드라인을 확인하십시요.)
      • Family Member
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      •  
      • Condition Description
      • Condition Date
    • Sponsor Information (if applicable) (소개하신 분이 회원이신가요? )

      • Member Name
      • Member Number**
      • **If you don't know the Member Number, please use the comments field at the end of this application to submit more information about the sponsoring membership.
        (소개한 분의 회원번호를 적어주세요. 회원번호를 모르시면 이름을 (영어로) 쓰시고 맨 아래 코멘트칸을 이용해서 주소나 전화번호를 적어주십시요)
    • Payment Information

      • Start Date
      •  
      •  
      • Promotion Code
        (if applicable)
      •  
      •  
      • Group Name
        (if applicable)
      •  
      •  
      • Payment Method
      • Credit Card:
      • Bank Withdrawal:
        • Type
        • Credit Card Number
        • Expiration
        • /
        • Payment Billing Interval
    • Forward Information About Christian Healthcare Ministries to Your Friends

    • (You can earn a free month of participation for each one who joins the ministry.)
      (크리스천 헬스케어를 친구에게 소개해 주세요. 귀하의 한달치 회비를 선물로 드립니다.)
      • Full Name
      • Address
      • City
      • State
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      •  
      • Zip
      • Phone
      • Email
    • How did you hear about us? (크리스천 헬스케어를 어떻게 알게 되었나요?)

    • Additional Comments (전하고 싶은 말, 섬기는 교회(성당), 이름을 적어주세요.)

    •   By clicking the submit button below, I am submitting this application to become an active member of CHM and attest that the participating adult members included herein are Christians living by biblical principles; attend group worship regularly (health permitting); follow scriptural teaching with regard to alcohol; and do not use tobacco or drugs illegally. I also attest that all information provided herein is true to the best of my knowledge.
      (나는 지금 CHM의 회원되기를 신청하는 바입니다. 참여를 신청하는 나와 내가족은 크리스천으로서 성경적인 원리를 지키며, 건강이 허락하는 한 예배에 정규적으로 참여하고, 성경이 가르치는데로 술을 삼가며, 담배와 마약을 하지 않음을 증명합니다. 또한 신청서안의 내용들이 모두 사실임을 증명합니다. 가입신청에 필요한 모든 정보가 확인되면1-2일 안에 가입확인 이메일을 받으십니다. 또 약 2-3주 후 회원카드를 포함한 새회원 환영페키지를 우편으로 받게 됩니다.)