2024 Associate Membership Renewal

Associate Membership Application
Company Name*
Preferred Mailing Address (if different)

Street Address

Street Address Line 2

City, ST ZipState Zip

Postal / Zip Code
Primary Contact/ Communications To*

First NameLast Name
Cell Phone Number
Phone*
Toll-Free
Fax
E-mail*
example@example.com
Website
ELIGIBILITY: Associate members shall consist of persons or entities having an interest in health services and involved in activities related to home and community support services (HCSSA). A person or entity affiliated with one or more licensed home and community support services agencies through ownership, control, or management may only be an associate member if at least one of the affiliated licensed home and community support services agencies is a current provider member. This includes affiliation through a spouse.Certified or licensed home and community support services agencies or statewide associations whose membership is comprised of certified or licensed home and community support services agencies are not eligible for associate membership.
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My company is not affiliated with a HCSSA in accordance with TAHC&H Bylaws,Article III, §4a, and is eligible for Associate Membership.HCSSA license pending (Notify TAHC&H upon receipt of HCSSA License so that we can change your classification of membership to Provider member and add you to the directory and provider list.Out of State Home Care AgencyMy company is affiliated with a HCSSA
List Affiliated TAHC&H Member Agency/ies, if applicable:
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Payment

View benefits for each tier here.
Dues
prevnext( X )
Basic
$900.00



Enhanced
$1,500.00



Ultimate
$2,100.00



Total

$0.00
*Contributions or gifts toTAHC&H are not tax deductible as charitable contributions for income tax purposes. However, they may be tax deductible as ordinary and necessary business expenses subject to restrictions imposed as a result of association lobbying activities. TAHC&H estimates that the deductible portion of your dues allowable to lobbying for 2022 is 75%. TIN #74-1887889
9390 Research Blvd., Bldg. 1, Suite 300, Austin, TX 78759
(512) 338-9293 p ♦ (800) 880-8893 p ♦(512) 338-9496 f ♦ www.tahch.org
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Associate Membership Application