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

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Address

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:

Include Agency Name, Contact Name (First and Last Name), Address, Email, Phone
Click or drag a file to this area to upload.

Agency Primary Representative

Provide the information as you wish it to be listed
Name

Agency Alternate Representative

Provide the information for your alternate as you wish it to be listed
Alternate Representative Name

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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