Membership Application Pay by Check

Please complete the information below and mail in your application and payment to (make checks payable to):
Delaware Association for Home and Community Care
PO Box 7037
Wilmington DE 19803

Membership Type & Payment Plans

Multi-Licensed Additional Fee

Same Ownership licenses combined = Revenue Tier + additional fee for each additional license (excluding your primary membership license)

$350 per license | Enter the total amount for all licenses (except your primary)
$500 per license | Enter the total amount for all licenses (except your primary)

Please provide the following information and use the upload option below:

Click or drag a file to this area to upload.

Agency Primary Representative

Provide the information as you wish it to be listed:

Agency Alternate Representative

Provide the information for your alternate as you wish it to be listed:

Share the Knowledge:

Members may add as many staff as you wish per paid member license. Multi-licensed Members: If you have remote support office staff employed by your company at a non-licensed location and wish for them to be included in DAHCC communications, you may include them as staff of your primary license membership.
Click or drag a file to this area to upload.
(as acknowledgement all information is accurate)

Payment Information

Make checks payable to and mail to: Delaware Association for Home and Community Care, PO Box 7037, Wilmington DE 19803
$ 0.00
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