Life Status Application

Life Status Application
Life status is available to Fellows who are retired* and have 25 years of combined membership at the Member, Fellow and/or Retired level, or if you are a Fellow unable to work full time due to a disability. With Life status, you can add LFACHE
after your name to reflect your longtime support of ACHE. You are entitled to many of the rights and privileges of ACHE membership. Visit ache.org/Retired for complete details.

*If you are semiretired, you must be working three days or fewer per week.
Personal Information
Member ID Number (If Known)
Current Fellow*

YesNo
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Retirement Date*

MonthDayYear
Date
Address*

AddressCityStateZip
Email Address*
example@example.com
You must meet the following requirements to be eligible for Life status:
Choose one*

I am retired or semiretired after at least 25 years of ACHE membershipI am a Fellow who has become disabled and unable to work full time (25 tenure year requirement is waived).
The information provided on this application is accurate and complete. I agree that if I am granted Life status in ACHE, I will continue to abide by ACHE’s Bylaws, Code of Ethics and other rules and regulations (found on ache.org/Ethics) and that I will alert ACHE if I return to full-time employment status..
Signature*

Clear
DATE

MonthDayYear
Date
Choose Your Life Status Member Benefits
Life Fellow membership is complimentary and includes a print copy of Healthcare Executive magazine and electronic access to our two journals. However, you can choose to receive print subscriptions to the journals for a $75 annual fee.
I wish to receive a complimentary membership.I wish to add print periodicals to my complimentary membership and agree to pay an additional $75 fee. I will be invoiced upon approval of my application.
You will be contacted annually by mail regarding your work status, mailing and billing options as a Life Fellow.
Should be Empty:

Life Status Application

Personal Information

Choose Your Life Status Member Benefits