Membership Application How to Submit This Application
Membership Application Company Name ______________________________________________________________________________________ Contact Person [Mr.] [Ms.] [Mrs.] ______________________________________ Title______________________________ Address _____________________________________________________________________________________________ City _______________________________________________________ State ___________ Zip _____________________ Telephone __________________________________________ FAX ____________________________________________ Email _____________________________________________ Website _________________________________________ Year founded: ___________ Number of Employees: ________Target Audience: __________________________________ Provide a brief description of products or services for inclusion in the next LeadingAge California Membership Directory (up to 30 words)
____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Goods and Services Provided to Senior Market:
Accounting Architecture/Interior Design Building Maintenance Communication/Emergency Services Construction Consulting Education/Training Emergency Call/Resident Monitoring Systems Emergency/Disaster Management Energy/Utilities Facility Development/Mktg.
Finance Flooring Food Service/Mgmt. Fundraising Furniture/Furnishings Group Purchasing Health/Wellness Housekeeping Insurance Internet Services/Telephone Legal Marketing Medical Equipment
Choose Your Membership Level (Details on back)
Premier Partnership ....................................................... $5,380 Enhanced Membership ................................................... $1,820 Basic Membership ............................................................ $800
Medical/Pharmaceutical Personal Care Products Property Management/Real Estate Public Relations Publications Rehabilitation Services Safety Products Security/Crime Prevention Technology Television Services Transportation
10% of your dues supports LeadingAge California PAC (Political Action Californians they serve. If you would like to opt-out of this contribution please submit a request in writing to [email protected].
Membership amount $ ________________ Check VISA MasterCard American Express Card # ____________________________________________________________________ Exp. Date _________________ Name on card ___________________________________ Cardholder’s signature _________________________________ Signature:_______________________________________________________
Date: _______________________________________________________
How to Submit This Application
Send this completed application to LeadingAge California via fax at (916) 428-4250 or email at [email protected]. If you have questions, please contact Melanie Ripley, Director of Membership, at LeadingAge California at (916) 392-5111. Thank you for becoming a valued member of the LeadingAge family!
No refunds on annual membership dues. Privacy Consent Language for LeadingAge California Communications: Whenever I provide e-mail address(es) and fax number(s) to LeadingAge California the business and I are consenting to receive LeadingAge California communications by email and fax, including, but not limited to, conference/hotel registration notices, legislative updates, exhibitors’ communi-
Business Partner Membership Levels Basic $800
Enhanced $1,820
Premier Partner $5,380
Listing in Membership Directory
X
X
X
Listing on website in Buyer’s Guide
X
X
X
Eligible to participate in LeadingAge California Committees
X
X
X
Eligible to participate in LeadingAge California’s Engage Communities with Guest Blog
X
X
X
Member rates for education and meetings
X
X
X
Access to Engage, LeadingAge California Quarterly Magazine
X
X
X
Invitation to attend region meetings and be a Presenter
X
X
X
Discount on trade show booth
X
X
X
Benefit
X
Additional 15% discount on trade show booth
X
Additional 25% discount on trade show booth X
Half page ad in Membership Directory
X
Full page ad in Membership Directory Half page ad in four issues Engage Magazine
X
Electronic mailing list once per year (No email addresses) Opportunity to Submit a Feature Article
LeadingAge Membership includes your entire organization! LeadingAge California. (Excludes third party consultants.) Name
Title
Email
X
X
X
X
____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Goods and Services Provided to Senior Market:
Accounting Architecture/Interior Design Building Maintenance Communication/Emergency Services Construction Consulting Education/Training Emergency Call/Resident Monitoring Systems Emergency/Disaster Management Energy/Utilities Facility Development/Mktg.
Finance Flooring Food Service/Mgmt. Fundraising Furniture/Furnishings Group Purchasing Health/Wellness Housekeeping Insurance Internet Services/Telephone Legal Marketing Medical Equipment
Choose Your Membership Level (Details on back)
Premier Partnership ....................................................... $5,380 Enhanced Membership ................................................... $1,820 Basic Membership ............................................................ $800
Medical/Pharmaceutical Personal Care Products Property Management/Real Estate Public Relations Publications Rehabilitation Services Safety Products Security/Crime Prevention Technology Television Services Transportation
10% of your dues supports LeadingAge California PAC (Political Action Californians they serve. If you would like to opt-out of this contribution please submit a request in writing to [email protected].
Membership amount $ ________________ Check VISA MasterCard American Express Card # ____________________________________________________________________ Exp. Date _________________ Name on card ___________________________________ Cardholder’s signature _________________________________ Signature:_______________________________________________________
Date: _______________________________________________________
How to Submit This Application
Send this completed application to LeadingAge California via fax at (916) 428-4250 or email at [email protected]. If you have questions, please contact Melanie Ripley, Director of Membership, at LeadingAge California at (916) 392-5111. Thank you for becoming a valued member of the LeadingAge family!
No refunds on annual membership dues. Privacy Consent Language for LeadingAge California Communications: Whenever I provide e-mail address(es) and fax number(s) to LeadingAge California the business and I are consenting to receive LeadingAge California communications by email and fax, including, but not limited to, conference/hotel registration notices, legislative updates, exhibitors’ communi-
Business Partner Membership Levels Basic $800
Enhanced $1,820
Premier Partner $5,380
Listing in Membership Directory
X
X
X
Listing on website in Buyer’s Guide
X
X
X
Eligible to participate in LeadingAge California Committees
X
X
X
Eligible to participate in LeadingAge California’s Engage Communities with Guest Blog
X
X
X
Member rates for education and meetings
X
X
X
Access to Engage, LeadingAge California Quarterly Magazine
X
X
X
Invitation to attend region meetings and be a Presenter
X
X
X
Discount on trade show booth
X
X
X
Benefit
X
Additional 15% discount on trade show booth
X
Additional 25% discount on trade show booth X
Half page ad in Membership Directory
X
Full page ad in Membership Directory Half page ad in four issues Engage Magazine
X
Electronic mailing list once per year (No email addresses) Opportunity to Submit a Feature Article
LeadingAge Membership includes your entire organization! LeadingAge California. (Excludes third party consultants.) Name
Title
X
X
X
X
