Apply/Renew Lehigh Valley Aging in Place Coalition

Member Renewal Only

PLEASE NOTE.
ALL members renewing must completely fill out the form.

Fields with an asterisk (*) are required.

Use this form ONLY if you wish to pay online now for your application.

Renewing members: fill in any changes to current listing. If no changes are submitted your listing will be the same as last year.

Company Name(*)

Please type your full name.

Contact name to be displayed in guide(*)

Please type your full name.

Title

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Address (Street Number, Address, City, Zip)

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Phone

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Cell

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Fax

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E-mail

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Website

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Please rewrite your description (max 450 characters)(*)

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How long have you been in business providing this service/product?

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Please list associations /organizations in which you hold memberships

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Comments

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Explain how your organization benefits seniors(*)

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What committees you would like to join or receive info:

MEMBERSHIP - assist in renewing memberships and recruiting new members
BY-LAWS - assist in maintaining and editing the by-laws, as needed
EDUCATION - assist in finding and coordinating community and corporate educational events
FUNDRAISING - support the committee in fundraising activities
MIXERS - assist in coordinating mixers
NOMINATING - assist in reviewing new member applications, meeting new applicants and presenting applications to the board
PUBLICITY/WEBSITE/MARKETING - assist with external communications and marketing of LVAIP
DANCE - help plan and coordinate the event each October
SENIOR EXPO - help plan and coordinate the May expo
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Annual Membership dues: $145
Membership provides one listing in the Annual Resource Guide and conveys all other rights and privileges of membership.

Member Dues
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Total Price
0 USD

Please Note: You do not have to have a PayPal account to pay for your tickets.
Paypal will accept your payment method without needing a PayPal account.

Anti-Spam(*)

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