Associate Member Application

Application for Associate Membership

Denominational Health Association

APPLICATION FOR ASSOCIATE MEMBERSHIP

The following would like to apply for associate membership in the Denominational Health Association:

Name of Society/Organization

Mailing address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Does your organization provide residential services? This includes affordable housing, supportive housing, assisted living or complex care.

Yes

If the answer to the above is yes – how many places (beds) do you have in B.C.

Membership fees are calculated on bed numbers for facilities providing that service.

Fees:

100 beds or less - $500
101 to 200 beds - $750
Over 200 beds - $1,000.00

The fee for organizations that provide community based health services but who have no residential services fall into the same fee structure as facilities with less than 100 beds – i.e. $500.00.

Please e-transfer your fee to [email protected]

In applying for membership in the Denominational Health Association (DHA), we agree to respect the bylaws and constitution of the DHA.

Name of Signing Authority

Date / Time