ONLINE APPLICATION

Company/Organization Name* 
First Name* 
Last Name*
 
Street Address*

City*
 
State*
  
Zip* 

Phone*

Email*

Description of business or affiliation to assisted living industry* 
PAYMENT
Card Type*  

Credit Card #*  
Expiration Date*

Security Code*  

Name on Card*  
Billing Zipcode*  

Membership Level
Total Dues: $ 
I (we) hereby submit the information above for the consideration of the Membership Committee and/or theBoard of Directors and apply for membership with the SC Association of Residential Care Homes. I (we)agree to comply with all rules and regulations as set forth by SCARCH standards including the bylaws andCode of Ethics. Please submit method of payment at time of application and payment will only be processed after approval for membership. Membership will be reviewed and an answer will be given within seven (7) days of submission. Please note 25 % of SCARCH dues are allocated for lobbying, consulting & legislative efforts and are not allowable as a business expense.
Signature of Approval* 

Date 

Please note 20% of dues are allocated to lobbying, consulting & legislative
efforts and are not allowable as a business expense.
   
INDUSTRY PARTNER:
Independent living, nursing homes, hospitals, hospice, home health, and any other senior housing/service/care alternatives, including developers or companies in process of building.
$500 per year