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NAHHH Newsletter

May, 2008
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Membership Information

APPLICATION FORM

Member Information

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Membership Category*

House Member - $425 annually. Open to operating non-profit hospitality house programs. House Members are voting members of NAHHH (one delegate per house).
Provisional Member - $275 annually. Open to those actively working to establish a hospitality house program. May or may not yet have non-profit status. Provisional members become eligible for House Membership once operational.
Affiliate Member - $275 annually. For any group, corporation, or individual interested in fostering development of the NAHHH concept. Open to for-profit and non-profit organizations.

Organizational Data

HHH Facility Name*
(or proposed name):
Name of Primary Contact*:
Primary Contact Position*:
Address*:
City*:
State*, Zip*: ,
Phone*: Fax:
Email*:
Website:
(do not enter http://)

Hospital Hospitality House Data

Number of rooms*:
Hospitals served*:
People served*:

Credit Card Payment

Card type*: Visa Mastercard
I'm ordering with a check or money order
Name of cardholder:
Credit card number:
Expiration date:

Non-Profit Status*

Independent Non-Profit Organization
(You must provide a copy of your 501c3.)
For Profit Organization
Group or Individual interested in supporting the NAHHH concept in general and/or actively working to establish a home.

Dependent Non-Profit Organization
(You must provide a copy of the 501c3 status of your sponsor and proof of your affiliation with the sponsor.)

Please provide the name and type of the sponsoring organization under whose non-profit affiliation you operate.

Name of Sponsoring Organization:

Type of Sponsoring Organization
Hospital Church Hospital Auxiliary
Service Club Foundation
Government Agency Separate Non-Profit Organization
Other

* As a House/Provisional/Affiliate Member, we recognize our responsibility to participate actively in the business of the Association, including responding to surveys, submitting statistical data on services rendered, attending and actively participating at the Annual Meeting, and complying with the various provisions of the NAHHH By-laws.

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