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National Association for Home Care & Hospice
Associate Application

Fields marked with a * are required fields.

1. Provide Your Information

Contact Person*:
Agency Name*:
Name (con't):
Address*:
Address (con't):
City*:
State*:
Zipcode*:
Country:
Phone*:
Fax:
Web Address: http://
Email*:

2. Calculate Your Investment

These benefits are designed to help you save while marketing your products and services to the leaders in Home Care & Hospice:

Deeply discounted advertising and mail list rental rates
Discounted exhibit space
Expert advice from NAHC staff
Monitor the provider member listserve (additional fee)
Subscriptions to NAHC publications and more.

For more information on how you can best use the many benefits of Associate Membership with NAHC, please give us a call!

Membership investment

2006 Associate Member $1,000
Listserve Subscription (optional) $ 500

3. Affiliate Membership/Optional Subscriptions

There are benefits in joining NAHC's affiliate associations; such as, topic specific discussion groups.

Dues

Listserve Subscription $500

Home Care Technology Association of America see below

If your organization provides technology-related services or products, dues are based on corporate home care and hospice sales:

$ 25,000,000 + $9,000

$20,000,001-$24,999,999 $8,000

$15,000,001-$19,999,999 $7,000

$10,000,001-$14,999,999 $6,000

$5,000,001-$9,999,999 $5,000

$1,000,000-$5,000,000 $4,000

Less than $1,000,000 $3,000

4. Payment Information

Credit Card Type*:
Card Number*:
Expiration*:	/
Name on Card*:

Please contact our Membership Services Department today to find out how NAHC Membership can help your business today.

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