LAACHA Membership Application

Membership in the Los Angeles Alliance for Community Health and Aging (LAACHA) is open to any corporation, partnership, joint venture, company, business association, academic institution, governmental entity, community-based organizations or individuals with a genuine interest in partnering with LAACHA members to promote health equity for older adult residents and caregivers, particularly those at-risk or who are marginalized, in the Los Angeles region.

Organizations and individuals meeting qualifying membership criteria shall be admitted to membership upon the completion and submission of a Membership Application and payment of the applicable membership fee.

All Members must abide by the Membership Agreement and any policies, guidelines or procedures adopted by the LAACHA Steering Committee.

Please submit your payment to LAACHA by mail to:
Los Angeles Foundation on Aging (LAFA)

Address:

11909 S. Hawthorne Blvd Suite 206

Hawthorne, CA 90250

Make check payable to LAFA and indicate in the memo section...

For LAACHA - Membership Dues

LAFA is a LAACHA strategic Partner, which is a section 501(c)(3) nonprofit organization. Employer Identification Number (EIN): 13-4334980. Your membership dues and/gifts may qualify as a charitable deduction for federal income tax purposes because no benefits or services were provided in return for donation. LAACHA advises donors to consult with their tax advisors or the IRS to determine whether a contribution is deductible.

To answer any membership questions/concerns, please contact:
Viviana Criado, LAACHA, Project Manager
Direct: (626) 293-2603 I Email: vcriado@ph.lacounty.gov

Question Title

* 1. Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. Please select one of the following options: (See Membership Information/Dues for explanation of categories)

Yes! I would like to join LAACHA in the following category: (please place a check mark next to it)

Sponsor Member ($5,000+ level of contribution support)

Associate Member ($250 level of contribution support)

Individual Member ($25.00 level of contribution support)

Student Member (Free)

Question Title

* 3. With my signature below, I am indicating my own or my organization's commitment to LAACHA's Mission and Membership Expectations.

Signature

Date

LAACHA Membership Application

Question Title

* 1. Contact Information

Question Title

* 2. Please select one of the following options: (See Membership Information/Dues for explanation of categories)Yes! I would like to join LAACHA in the following category: (please place a check mark next to it)

Question Title

* 3. With my signature below, I am indicating my own or my organization's commitment to LAACHA's Mission and Membership Expectations.

* 2. Please select one of the following options: (See Membership Information/Dues for explanation of categories)

Yes! I would like to join LAACHA in the following category: (please place a check mark next to it)