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SNF, ALF/PCH & SOURCE Membership Application
 
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Dues Structure

Skilled Nursing Membership Dues: $68 per licensed bed (includes AHCA dues of $20.60/bed & GHCA dues of $47.40/bed)

Assisted Living/PCH Membership Dues: $26 per licensed bed (includes NCAL dues of $10.50/bed & GHCA dues of $15.50/bed)

SOURCE Membership Dues: $650 - Case Load < 500, $1,000 - Case Load > 500


 
1.
Select the category of membership for which you are applying:*
 
 
 
 
 
 
2.
*
 
 
 
 
3.
Facility Address:*
 

 

 

 

 

 

 

 

 
 
 
 
4.
Primary Contact Person:*
 

 

 

 
 
 
 
  FOR SOURCE MEMBERSHIP APPLICANTS ONLY
 
 
 
5.

For SOURCE membership application only
 
 
 
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