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:

    How did you hear about us?

    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. Any communications from CALA are intended for members only and not to be distributed outside of your organization.

    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 $38
    5. Grand Total: (2+4)

    UNDER CONSTRUCTION

    Under Construction: $380

    Scheduled Opening Date:

    PAYMENT

    Total Amount Due:

    Please choose from the following:

    Annual paymentsQuarterly payments

    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