Apply/Renew Lehigh Valley Aging in Place Coalition

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

Fields with an asterisk (*) are required.

To renew, please fill in any changes to update your listing. If no changes are submitted your listing will be the same as last year. To review your listing, please click the Member Directory and search for your listing.

Company Name(*)

Please type your full name.

Contact name to be displayed in guide(*)

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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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Would you like to update your description in the guide from last year?(*)

Yes
No

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If you would like to re-write your description please do so here (max 450 characters)

0

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Upload your logo (jpg, gif, png)

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Comments

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What committees you would like to join or receive info:

MEMBERSHIP - assist in renewing memberships and recruiting new members
EDUCATION - assist in finding and coordinating community and corporate educational events
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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Member Dues

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Total Price

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Choose Payment

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Please Note: You do not need a PayPal account to process your payment.
Paypal is the processor for your credit card.

If you need to pay by check please enter your email address receive an invoice.

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LV Aging In Place

Member Renewal Only