Corporate Partner Program Application Corporate Partner Program Application January 1 - December 31, 2024Applications for 2024 will be accepted until September 30, 2024. After September 30th it will be processed for 2025 Corporate Partnership. Company Information (Published to directory) Company Name Mailing Street: City: State: ZIP: Phone: Website: Company Relationship This Company is owned by a current LeadingAge Provider Member Provider Member Name: Full Address: Company Contacts Primary Contact: Title: Phone: Email: Secondary Contact: Title: Phone: Email: Product/Service Category Please choose a primary category and, if applicable, a secondary category: 1st Choice:Please select... Accounting Accreditation Actuarial Adult Day Services Advertising Appliances Architecture Assn/Education Banking Bathing Systems Bedding Billing Services Brain Fitness Brand Identity Building Equipment/Products Communication Systems & Services Computer/Data management/Software Construction Consulting Dairy Supplier Dementia Engagement Design/Build Development Services Disaster Response Distribution E-Learning for Staff Training and Development Electronic Medical Records Emergency Response Systems Engineering Entertainment Environmental Services Executive Search/Recruitment Facility Management Federal Government Assistance Financial Services Fire Safety/Prevention Flooring Food Management Food Service Fundraising/Business Development Furniture Government Agency Group Purchasing Hand Hygiene Housekeeping Human Resources Systems/Services Identification Systems Information Technology In-Home Health Care Products and Services Insurance Interior Design Internet Services Legal Services Lifts Lighting Maintenance Supplies Management Services Marketing & Communications Master Planning Meal Delivery Systems Medical Products & Services Nutrition Management Office Supplies Ozone Systems Pest Control Pharmaceutical Pharmacy Services Procurement Services Project Management Publishers Quality Improvement Real Estate Rehabilitation/Therapy Services Research Resident Care and Personal Products & Services Resident Monitoring Retirement Planning Safety Seating Signage Technology Assistive Devices Telehealth Products & Services Transportation TV Systems Utilities Wander-Fall Prevention Wellness Programs & Equipment Wireless Communications 2nd Choice:Please select... Accounting Accreditation Actuarial Adult Day Services Advertising Appliances Architecture Assn/Education Banking Bathing Systems Bedding Billing Services Brain Fitness Brand Identity Building Equipment/Products Communication Systems & Services Computer/Data management/Software Construction Consulting Dairy Supplier Dementia Engagement Design/Build Development Services Disaster Response Distribution E-Learning for Staff Training and Development Electronic Medical Records Emergency Response Systems Engineering Entertainment Environmental Services Executive Search/Recruitment Facility Management Federal Government Assistance Financial Services Fire Safety/Prevention Flooring Food Management Food Service Fundraising/Business Development Furniture Government Agency Group Purchasing Hand Hygiene Housekeeping Human Resources Systems/Services Identification Systems Information Technology In-Home Health Care Products and Services Insurance Interior Design Internet Services Legal Services Lifts Lighting Maintenance Supplies Management Services Marketing & Communications Master Planning Meal Delivery Systems Medical Products & Services Nutrition Management Office Supplies Ozone Systems Pest Control Pharmaceutical Pharmacy Services Procurement Services Project Management Publishers Quality Improvement Real Estate Rehabilitation/Therapy Services Research Resident Care and Personal Products & Services Resident Monitoring Retirement Planning Safety Seating Signage Technology Assistive Devices Telehealth Products & Services Transportation TV Systems Utilities Wander-Fall Prevention Wellness Programs & Equipment Wireless Communications Join LeadingAge I agree to join LeadingAge at the following level:Associate Business Partner: $2,100Bronze Partner: $25,000Silver Partner: $55,000Gold Partner: $85,000Nonprofit Association/Organization: $1,050University: $1,050 Read about the power of membership and the benefits offered by the association. State Association Discount I am currently a member of a LeadingAge State Association and qualifyfor a maximum $100 discount, subject to verification. Enter State Association Name for verification: Payment Method Total Payment Due (USD): Payment Method:ACH or Wire Transfer (*)Check (Payable in U.S. Dollars to LeadingAge)Credit Card (MasterCard, VISA, AMEX, Discover) (*) View the ACH and Wire Transfer instructional PDF Card Payment Information Name on card: First Name: Last Name: Card Number: Security Code: Expiration: MM YYYY Card Billing Street Suite/Apt/Unit City State Zip Billing Confirmation Email Terms and Conditions Please read and agree to the terms and conditions in order to proceed:The Partnership selected is based on a calendar year, January through December 2024.Payment in full is due with the application or no later than January 15, 2024 in order for benefits to be activated for Corporate Partners. 50% payment is due with this application for Gold, Silver and Bronze partner levels with payment in full by June 1, 2024. Benefits will not be activated until the initial 50% payment has been made.The applicant has reviewed the benefits offered by the association * at the level requested.If for any reason any of the benefits listed cannot be activated by the association, benefits equal to, or comparable will be offered.Cancellation of the Partnership may be requested within 7 days of application acceptance and confirmation. After such time, this is a binding agreement for partnership, no cancellations will be accepted, and all partnership fees will have to be paid as originally agreed upon. Error: * Review the benefits offered by the association. Engagement How did you hear about the LeadingAge Corporate Partner Program:I was a member previouslyOnline search engineFriend/ColleagueEmail about the programContacted by LeadingAge Sales TeamState Association StaffOther Please provide further details: Authnet_Hidden_Fields reCAPTCHA helps prevent automated form spam. 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