Business Member Application

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Comments

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Name of Firm:*

Primary Contact/Representative:*

First Last

Primary Contact/Representative Title:*

Primary Contact/Representative Email:*

Additional Representatives

Additional Representative One Name:

First Last

Additional Representative One Title:

Additional Representative One Email:

Additional Representative Two Name:

First Last

Additional Representative Two Title:

Additional Representative Two Email:

Additional Representative Three Name:

First Last

Additional Representative Three Title:

Additional Representative Three Email:

Address For Directory:*

Street Address Address Line 2 City State ZIP Code

Is Mailing Address different than Directory Address

yes

Mailing Address:*

Street Address Address Line 2 City State ZIP Code

Phone:*

Fax:

Website

Please select (2-3) categories that most correspond to your services/products (LIMIT 3):

Accounting / Payroll

Advertising / PR

Architecture / Design

Clinical Care

Compliance Resource

Construction/Engineering

Consulting

Diagnostics

Education

Emergency Preparedness

Employee Benefit Services

Entertainment

Environmental Services

Equipment

Financial Services

Flooring

Food Service

Furnishings

General Contracting/Building

Heating, Ventilation and AC (HVAC)

Home Care

Housekeeping/Linens/Laundry

Institutional Pharmacy

Insurance

Interior Design

Laboratory Services

Legal Services

Life Safety Solutions

Linen Services

Marketing

Medical Supplies

Pharmaceutical

Physician/Nurse Practitioners

Purchasing Programs

Reimbursement

Retirement Planning

Risk Management

Salon / Spa Services

Senior Transition Specialists

Staff / Recruiting

Sustainability

Technology/Computer/Software

Telecommunications

Therapy / Rehabilitation

Transportation

Wound Care

X-Ray Services

Other

Other Category:

Please tell us about your company for our Directory:

Is your firm part of a larger corporate structure?

yes

What is the name of the parent organization?

What services / products does it provide, and to whom?

Does the parent corporation or any of its subsidiaries operate nursing homes, facilities, agencies or institutions for the aging?

yes

in what states?

How did you learn about LeadingAge Washington?

Membership Options*

Diamond $10,500

Ruby $8,000

Sapphire $5,500

Emerald $3,000

Pearl $1,250

Opal $650

Your Name:*

First Last

Membership Renewal: Membership is automatically renewed each year. Notification of changes regarding level or changes in options must be received by 12/31*

I understand

Please make checks payable to LeadingAge Washington, 1102 Broadway, Ste 201, Tacoma, WA 98402. If you have any questions or issues submitting this form, please contact Cassi at cmeritt@leadingagewa.org. Thank you for your interest.

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Business Member Application

Additional Representatives

Upcoming Events

InsPAC2025 Webinar Series: Leadership Essentials for Healthcare Administrators and DONs

Activities (SNF) & Social Services Professional Network

InsPAC2025 Webinar Series: Resident Rights and Abuse Prevention: Compliance and Culture

Latest News

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