Home Care & Hospice Alliance of Maine
2023-24 Membership Application

Membership Year: June 1, 2023 - May 31, 2024

Name:

Email:

Agency/Company:

Website:

Medicare-Certified Home Health Agency

Medicare-Certified Hospice

State Licensed Home Care Agency

Registered Homemaker/Personal Care

Associate/Allied (provides goods/services but not direct care in the home)

Individual/Sole Proprietor (appropriate for self-employed consultants)