CCRC Membership Application


COMMUNITY INFORMATION

Community:

Address:

City, State, Zip:

Phone:

Fax:

Website:

Facility License Number:

Primary Contact

Contact Person:

Title:

Email (required):

MANAGEMENT COMPANY/OWNER INFORMATION

Management company, if applicable. If not, owner:

Contact Person:

Title:

Address:

City, State, Zip:

Phone:

Fax:

Email:

Website:

CALA Member companies are required to enroll all California RCFEs into membership. If you have a community under development, the fee structure is based on the minimum fee per location. Once your community opens, membership fees will be based on your RCFE licensed units. One primary member/contact at each location receives all mailings. All employees at each location are considered members for conference and product pricing.

DUES CALCULATIONS

1. Total No. of Licensed Units/Rooms: (not licensed capacity)

2. Please check appropriate amount below

Total Licensed Units Dues
Up to 50 $750
51-100 $1,000
101-150 $1,500
151-250 $2,000
251 and above $2,500


3. No. of Units/Rooms in which AL services are provided:
4. AL Units (#3) x $33
5. Grand Total: (2+4)

UNDER CONSTRUCTION

Under Construction: $330

Scheduled Opening Date:

PAYMENT

Total Amount Due:

Please choose from the following:

Annual paymentsQuarterly paymentsMonthly automatic payments (available for communities with 50 units or above, credit card on file and processed by CALA)

Payment Method:

Check(Make payable to CALA)Credit Card (VISA, MC, Amex)

Card Number:

Exp Date:

Cardholder Name:

*Membership begins upon receipt of payment

CALA dues are not tax deductible as charitable contributions. However, they may be partially deductible as business expenses. CALA estimates that 19% of your dues are not deductible due to CALA's lobbying activities on your behalf.

If opting to pay by check, please mail to: CALA, 455 Capitol Mall, Ste 222, Sacramento, CA 95814. Checks must be received before processing membership.

ACKNOWLEDGEMENT

I understand that by becoming a CALA member, my company consents to receive communications by or on behalf of CALA duly authorized agents or designees, via postal mail, fax, email and/or telephone.

Please have Argentum contact me regarding membership