Application Information

AGENCY MEMBERSHIP Application Information

Eligibility: Agency members are organizations directly employing home care aides and meeting the standards of training, supervision and administration established by our Council. Dues are on a sliding-fee scale.

Summary of Benefits: Access to Information  Subscription to Council Update newsletter  Learn how your agency can comply with state and federal home care aide policies and contracting requirements  Get the latest information impacting the Massachusetts home care industry via Council email alerts  Access to Members-Only section of our website to include our new “Frequently Asked Home Care Aide Standards Questions” Section

Benchmarking Opportunities  Participate in Council’s Annual Private Pay Survey and Receive Free Summary Benchmarking Report

Discounted Training Publications and Member Events  Purchase our Publications at the low-cost “Members Only” rate  Attend all Council Events, Educational Programs, and Conference at the low-cost “Members Only” rate

Marketing Opportunities  Participate in the Council’s Agency Member Logo Program. Add the Council’s Member Logo to your website, signage, reports, brochures, and other publicity or display materials.  Listing in the Council’s new on-line Agency Membership Directory (alphabetically, by region, and by type of service) including a Hyperlink to your business website from Council’s site

Workforce Development  Nominate your home care aides and supervisory staff to review recognition at the Council’s Annual Home Care Aide Celebration cosponsored by the Executive Office of Elder Affairs  Refer Potential Candidates to Council’s PHCAST Personal Care Homemaker Training Classes  Send your supervisory staff to regular training and supervision opportunities  Member’s Only Access to Council’s Library of Home Care Aide Training Videos

Networking  Opportunities to network with home care agencies, elder care organizations, and vendors through our Annual Meeting, Spring Conference, and other events  Meet with and learn from home care agencies in your area at our Regional Meetings

HOME CARE AIDE COUNCIL, INC. www.hcacouncil.org  124 Watertown Street, Suite 2E  Watertown, MA 02472  (617) 744-6561 AGENCY MEMBERSHIP 2017 Application Form-NEW MEMBER

Agency Name: Phone:

Street Address: Fax:

City: State: Zip:

Contact Name: Title:

Contact Email address:

Agency Website: Year Established

Federal EIN Number: Agency Membership dues are based on your 2016 Massachusetts home care aide payroll per the following schedule: Tier Home Care Aide Payroll Agency Membership Dues 1 Less than $500,000 $750 2 $500,000 - $999,999 $1,500 3 $1,000,000 - $1,999,999 $2,000 4 $2,000,000 - $2,999,999 $2,500 5 $3,000,000 - $4,999,999 $3,000 6 $5,000,000 - $6,999,999 $5,000 7 $7,000,000 or over $7,000

Please indicate your 2016 Massachusetts Home Care Aide wages $ (Agencies choosing not to submit payroll data will be charged dues of $7,000)

I confirm that the information above is complete and accurate. I understand that my company’s membership dues are not refundable and dues payment must be paid in full within six (6) months of the date listed below.

Authorized Signature Date

Please note that 9.4% of your 2017 Annual dues are not tax deductible because they are associated with lobbying activities.

New Member Eligibility for Special Member Pricing

HOME CARE AIDE COUNCIL, INC. www.hcacouncil.org  124 Watertown Street, Suite 2E  Watertown, MA 02472  (617) 744-6561 The Council requires that first year Annual Membership dues must be paid in full in order to take advant age of member discounts on publication costs and event registration fees.

HOME CARE AIDE COUNCIL, INC. www.hcacouncil.org  124 Watertown Street, Suite 2E  Watertown, MA 02472  (617) 744-6561 PAYMENT INFORMATION

Please check one:

 Dues Enclosed: Amount Paid: $

 Please Bill Me:

 One Payment

 Two Payments (This Payment Option is Available for Tier 3-7 only)

Checks can be made payable to: Home Care Aide Council 124 Watertown Street, Suite 2E Watertown, MA 02472

To pay by credit card (VISA, MasterCard, American Express only), please complete the information below.

Card Number

Exp. Date / (Month/Year)

VISA/MasterCard 3-digit code on reverse American Express 4-digit code on front

Cardholder’s Name

Billing Address

City State Zip

Signature of Cardholder

Please return this form and payment to the Council office by mail at the address above, or email to [email protected], or by fax to (781) 209-5977.

HOME CARE AIDE COUNCIL, INC. www.hcacouncil.org  124 Watertown Street, Suite 2E  Watertown, MA 02472  (617) 744-6561