Naga Imaging Center Cooperative (NICC) values and protects your personal information in accordance with the Data Privacy Act of 2012.
By completing this form, you consent to the collection and processing of your personal information for the purpose of evaluating and processing your application for Associate Membership, maintaining membership records, communicating with you regarding your application, and complying with legal and regulatory requirements.
Certain information may also be collected solely for statistical analysis, demographic profiling, and cooperative planning purposes. Such information is optional and will not affect the evaluation or approval of your Associate Membership application.
NICC will take reasonable measures to protect your information and will not share it with unauthorized third parties except when required by law.
By submitting this form, you confirm that you have read and understood this Privacy Notice and voluntarily consent to the processing of your personal information.
Associate Membership Application
Please complete all sections below. It only takes a few minutes.
* Required field
1
PMES
2
Personal Info
3
Parent / Spouse
4
Subscription Agreement
5
Upload Documents
6
Review & Submit
Your information is kept confidential and used solely for membership processing. View Privacy Notice