Membership Information Request Form

Serving People Through the Continuum of Long-Term Care

Request Membership Information Choose the category of membership you're interested in. If you'd like a phone call, be sure to fill in the phone number and give us a good time to call in the message box at the end of the form below. If you'd like materials mailed to you, be sure and supply your name and mailing address in the appropriate spaces. STOP! If you are ALREADY a member and need a password, click here!
Membership category:
Your name:
Title/Job Function:
Facility or company name:
Number of beds in your facility:
Address:
City, State, ZIP:
Phone:
E-mail Address
Enter any comments:

California Association of Health Facilities | 2201 K St., PO Box 537004
Sacramento, CA 95853 | 916.441.6400 | Fax 916.441.6441