Providers' Council Associate Member Renewal Form

ASSOCIATE Membership Application

Thank you for your interest in the Providers' Council's ASSOCIATE membership. Membership runs on a calendar year (January through December).
Business/Organization Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business/Organization Phone Number
Contact Person*

First NameLast Name
Job Title
Current position at business/organization
Email*
example@example.com
Additional contacts:
Would you like to add additional contacts to this membership account?*

YesNo
Additional Contact (1)
Additional Contact (2)
Additional Contact (3)
Opportunities to be engaged with the Council. Check all that apply.

Link your business/organization website on our webpageInterest in presenting a webinar/training for our members in 2025Advertise in newspaper, e-newsletters in 2025Share the Councils' digital badge on your website
If checked, please share updated URL link below:
Associate Membership Dues

1 year Associate Membership = $600
How would you like to pay your annual 2025 membership dues?*

Credit card (Paying by credit card will incur a 3.5% convenience fee)CheckACH transfer
Membership Dues Total

prevnext( X )
USDDues are not deductible as a charitable contribution.
If paying by check please make checks payable to Providers' Council and mail to:
Providers' Council 100 Crossing Blvd., Suite 100, Framingham, MA 01702

If you could like to pay with an ACH transfer email info@providers.org.

Membership lasts for the calendar year: January through December.

Questions? Contact ann@providers.org or 508.598.9800.

Should be Empty:

ASSOCIATE Membership Application

If paying by check please make checks payable to Providers' Council and mail to: Providers' Council 100 Crossing Blvd., Suite 100, Framingham, MA 01702

If paying by check please make checks payable to Providers' Council and mail to:
Providers' Council 100 Crossing Blvd., Suite 100, Framingham, MA 01702