Membership Form - Online Payments: Alberta Continuing Care Association

ACCA Membership Form - Online Payments

Please complete this form should you be making your membership payment online by credit card.

For payments by Electronic funds transfer (EFT) or cheque, please complete the ACCA Membership Form - Cheque or EFT Payments

Membership Information

This form is for organizations that do not provide any continuing care services (home care, designated supportive living, and long-term care). Continuing care operators, kindly contact the ACCA team for information on voting membership.

Please specify your membership type: *

Corporate Member: $1,500/Organization

Please specify your organization ownership type: *

Not for Profit

Private

Public

Organization Name: *

Address: *

Postal Code: *

Main Contact Information

Manages ACCA membership on behalf of your organization, updating contact information and
receiving any official ACCA correspondence.

Full Name: *

Title: *

Email: *

Note: This email will also be used as the location to send your payment confirmation email to

Phone: *

Additional Contacts

Please add any additional contacts from your organization below i.e., all other individuals in your organization that may want to receive ACCA communications, newsletters, and updates. Please include the contact name and email address, and any other relevant information.

Logo:

New members, please upload your organization's logo (png, jpeg or jpg)

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Organization Description:

New members, please include a short description of your organization and the services and/or products you provide.

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