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» Provider Information » Provider FAQs » Join the IHG Network » Update Provider Record » Search for Provider » Provider Reference Card (PDF) » CA Payment Guidelines Join IHG Network - Membership Application Request Please fill out and submit the following to request an application. Fields with an asterisk (*) are required. My request is for * Physician application Group application Facility application Workers' Compensation Dental Application A value is required. Specialty Name * A value is required. Company E-mail * A value is required.Invalid format. Phone * A value is required. Address * A value is required. City * A value is required. State * - Select A State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP * A value is required.Invalid format. Comments or Questions