Home Care Council of PA — Founding Membership Enrollment
Join a professional community created for Pennsylvania non-medical home care agency owners, administrators, and agency leaders. Complete the information below to enroll your agency as a Founding Member.
Who This Membership Is For
Home Care Council of PA is a professional community for Pennsylvania non-medical/non-skilled home care agencies and the owners, administrators, and agency leaders responsible for operating them. This membership is not intended for Medicare-certified skilled home health agencies providing skilled nursing, therapy, or other skilled home health services.
Agency & Member Information
First Name
*
Last Name
*
Agency Name
*
Title / Position
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Agency Street Address
*
City
*
State
*
Please Select
Pennsylvania
Other
ZIP Code
*
Pennsylvania County Where Agency Is Located
*
Please Select
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
Statewide / Multiple Regions
Select the Pennsylvania county where this agency location is physically located.
MULTIPLE PENNSYLVANIA LICENSED LOCATIONS
Does your organization operate more than one separately licensed Pennsylvania home care agency location?
Please contact Home Care Council of PA at info@homecarecouncilofpa.com before completing enrollment or submitting payment for information regarding multi-location enrollment.
Agency Website
Agency Logo
Upload your agency logo for inclusion on the Home Care Council of PA website and other Council member-recognition materials.
Agency Logo
Upload a File
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Choose a file
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of
By uploading my agency logo, I authorize Home Care Council of PA to display and use the logo for Council membership identification, website member listings, Founding Member recognition, and Council-related promotional materials.
I authorize the Home Care Council of PA to use my agency logo as described above.
*
I authorize the Home Care Council of PA to use my agency logo as described above.
PA Department of Health Home Care Agency License Number
I understand that Founding Agency Membership is $89 per month, per agency location, with billing beginning February 1, 2027. The Founding Member rate of $89 per month will remain in effect for continuously active Founding Members. Membership is issued to the Pennsylvania agency location enrolled on this form and is non-transferable. I acknowledge that Home Care Council of PA provides professional education, information, resources, and peer discussion and does not provide legal advice or guarantee regulatory compliance.
*
I acknowledge and agree
Authorization
Electronic Signature
*
Date
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Founding Agency Membership
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Founding Agency Membership
Home Care Council of PA Founding Agency Membership
Free for the first
6 Months
then,
$89.00
$
89.00
for each
month
Email
Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Membership is issued per Pennsylvania agency location. Each separately licensed Pennsylvania home care agency location requires its own membership, even when multiple locations operate under the same company or ownership. Authorized personnel of the enrolled location may access membership benefits and resources. Membership benefits and member-only resources do not extend to additional agency locations unless those locations maintain their own active membership.
Business Expense Notice: Membership dues may be tax-deductible as an ordinary and necessary business expense. Please consult your tax professional regarding your individual tax situation.
BECOME A FOUNDING MEMBER
BECOME A FOUNDING MEMBER
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