Membership Application – Assisted Living Providers


Community Information

Community:

Address:

City, State, Zip:

Phone:

Fax:

Website:

Facility License Number:

Primary Contact

Primary Contact

Contact Person:

Title:

Email:

Management Company

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.

Units/Rooms

Total RFCE Licensed Units/Rooms:

For Information Only: Total Licensed Capacity:

Dues are based on the number of licensed rooms per building at $34 per room, which translates to $2.83 monthly per resident room.

Dues Amount: No. of Units x $34 ($340 minimum) = Total:

Under Construction: $340

Scheduled Opening Date:

Payment Information

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)

*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.

Payment

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

Card Number:

Exp Date:

Cardholder Name:

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