2026 Membership Application Form

2026 Membership Application Form - Voting Membership
Organization Name:*
Enter your organisation’s full legal name as it appears on your licence, registration, or public materials
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Primary contact number for your organisation Format: (000) 000-0000.
Website:
If you have a website, please include the full URL
Classification
We use this data to understand the mix of providers we represent when engaging with government and stakeholders.

Your Organisation’s Key Contacts

Accurate contact details help us keep your organisation connected and represented in ACCA’s advocacy efforts.
Primary Contact*

First NameLast Name
Title:*
Email*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please add any additional contacts from your organization i.e., all other individuals in your organization that may want to receive ACCA communications, newsletters, and updates.
My contact information (name, title, and email) being shared with the broader ACCA membership for the purpose of fostering collaboration, communication, and networking within the sector.My contact information being shared with government representatives or agencies when appropriate for ACCA’s advocacy, policy, or sector engagement work.

Tell Us About Your Services

Select all the care types you offer and provide site details so ACCA can accurately reflect your organisation’s work in our advocacy and reporting.
Home Care ServicesDesignated Supportive Living (DSL)Long-Term Care (LTC)HospiceSeniors’ Independent or Community Living
If you are applying as the Head Office for multiple sites, please indicate how many sites fall under your organization’s umbrella.
Home Care: Help us keep ACCA’s advocacy data accurate. Please add each of your sites below, including address, hours of care, and staffing details. Use “Save and Add Row” to record each location.
Designated Supportive Living: Help us keep ACCA’s advocacy data accurate. Please add each of your sites below, including address, spaces, and staffing details. Use “Save and Add Row” to record each location.
Long Term Care: Help us keep ACCA’s advocacy data accurate. Please add each of your sites below, including address, spaces, and staffing details. Use “Save and Add Row” to record each location.
Hospice: Help us keep ACCA’s advocacy data accurate. Please add each of your sites below, including address, spaces, and staffing details. Use “Save and Add Row” to record each location.
Senior Living: Help us keep ACCA’s advocacy data accurate. Please add each of your sites below, including address, spaces, and staffing details. Use “Save and Add Row” to record each location.
The information you provide here helps ACCA tell the story of Alberta’s continuing care sector more accurately. We report only aggregated data when working with government and stakeholders.
Total Hours of Home Care provided in the last year
Total # of DSL Spaces
Total # of LTC Spaces
Total # of Hospice Spaces
Total # of Seniors Community Spaces
Total # of employees at your organization*

Member Directory Profile
This information will appear in the ACCA Member Directory once your membership is approved. You can update your logo and organization description at any time to keep your listing current.
Logo:

Please upload the digital assets here (png, jpeg or jpg)
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Organization Description:
Provide a brief description of your organization for the ACCA Member Directory.
Please verify that you are human*
Should be Empty:

2026 Membership Application Form - Voting Membership

Your Organisation’s Key Contacts

Tell Us About Your Services

Member Directory Profile