BCCPA Membership Form (Current)

MEMBERSHIP FORM

Thank you for becoming a member of the BC Care Providers Association | EngAge BC this past year and for choosing to renew your membership. Your membership helps the Association support seniors living and care providers through advocacy and policy development; and to create networking and knowledge sharing opportunities. As always, our team would be happy to answer any questions you may have, or to spend sometime reorienting you to the benefits of membership Please fill out and submit the form below.
Date of Application*

MonthDayYear
Name of organization*
Name of parent organization, if applicable
Site address*

Street address

Street Address Line 2

CityProvince

Postal code
Billing address*

Street address

Street Address Line 2

CityProvince

Postal code
Contact name*
Job title*
Phone number*
E-mail*
What type of service do you provide? Please check all that apply.*

Long-Term CareAssisted LivingHome Health CareIndependent Living
Independent Living is defined as: Seniors’ housing where hospitality services are provided, such as meals, housekeeping, laundry and recreation activities. This definition does not refer to suites where the resident receives assisted living or care services delivered by the operator, nor does it include housing without hospitality services.
Please provide your WorkSafeBC employer ID:*
Please select your health authority?*

Fraser HealthIsland HealthVancouver Coastal HealthInterior HealthNorthern HealthNone of the above
What unions do you have at your location?*

BCGEUBCNUHEUNot unionized
Which union collective agreements do your staff fall under? Please select all that apply*

HEABC Community Subsector Collective AgreementHEABC Facilities Subsector Collective AgreementProvincial Nursing Collective AgreementHealth Sciences Professionals Collective AgreementIndependent Collective AgreementNon-unionized
Is your organization:*

For ProfitNot for Profit
You must fill out the service type sections applicable to you below for your application to be valid.

Long-Term Care
How many funded long-term care beds do you currently have?
How many private-pay long-term care beds do you currently have?

Assisted Living
How many funded assisted living units do you currently have?
How many private-pay assisted living units do you currently have?

Home Heath Care
How many hours of home health care do you provide per year?

Independent Living
How many independent living units do you have on site?
How many of the units are subsidized through BC Housing's Seniors' Supportive Housing Program?

Who will hold your vote(s) at the Annual General Meeting? *


First Name
Last Name
Email
Title

Please provide a primary contact for your membership? *

	Primary Contact - The main point of contact at the member organization. They are able to assign roles to people in the organization
First Name
Last Name
Email
Title

Please provide a billing contact for your membership? *

	Billing Contact - Responsible for paying for membership dues and are sent automated membership renewal reminders
First Name
Last Name
Email
Title

Do you consent to receive e-mail notifications from BC Care Providers Association and EngAge BC?*

YesNo
Please initial*
Should be Empty:

MEMBERSHIP FORM