Online Membership Application

Membership Application

STOP! Do not complete this application if you are a LeadingAge provider member.

Membership Options (Select One): *

Professional Membership: Single-site providers, individuals, including researchers that are interested in global ageing services and/or issues. (US $200 annually)

Organizational Membership: Includes multi-site providers, governments, associations or non-governmental organizations in the ageing services field or organizations that are interested in global ageing issues. (US $750 annually)

Business Members/Industry Partners: National or multi-national corporations and business leaders focusing on serving older adult providers and addressing the challenges and opportunities for ageing societies. (US $1,000 annually)

Contact Name:*

First

Last

Title:*

Organization Name:*

Operational Level:*

Organizational Function/Expertise:*

Member Information:

Street Address Street Address Line 2 City State / Province / Region Zip Code Country

Phone Number:

Email Address:*

Please answer the following questions in 300-500 words:

Why do you/your organization wish to join the Global Ageing Network?

What services does your organization offer?

How many people do you serve per year?

Newsletter

I would like to receive the Global Ageing Network’s monthly newsletter, Global Connections.

I would like to receive updates from the Global Ageing Network.

Membership Total:

Validation

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