Online Sign Up Form

Annual Dues Statement

Kansas City Regional Home Care Association fiscal year is September 1 through August 31.  Yearly dues are $200.00 for provider members and $50.00 for Honorary/ Courtesy members.  Annual paid dues allow ONE vote as well as minutes of each meeting e-mailed to the voting member.

**Please pay dues by September 30 each year

MEMBER (Voting privileges and active participation on committees and the Board)  $200

HONORARY/COURTESY (Home Care Providers are not eligible for this membership level)  $50.00

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Complete this Form to Join the KCRHCA

Name of Organization (required)

Name of Voting Member (required)

Voting Member Email (required)

Address

Phone

Fax

Website

 

Please choose the category under which your company will be listed (required):

 

Please select the services provided by your company:

 

Please select the committees you are interested in or would like more information on:

 

Who will be attending the monthly KCRHCA meetings? Please provide their names and email addresses below:

Administrator

Administrator Email

 

Clinical Manager

Clinical Manager Email

 

Therapy Coordinator

Therapy Coordinator Email

 

Social Worker

Social Worker Email

 

Private Duty Coordinator

Private Duty Coordinator Email

 

Hospice Representative

Hospice Representative Email

 

Volunteer Coordinator

Volunteer Coordinator Email

 

Chaplain

Chaplain Email

 

Please be advised: Only click the “Send” button once.

 

Remember: Make checks payable to Kansas City Regional Home Care Association, Inc. and mail to:

Pam Holmes KCRHCA
3 S. Julie St.
Louisburg, KS 66053
 

New Members Only – Prorated dues after September 30th :

Oct-$187.00        Nov-$170.00     Dec-$153.00     Jan-$136.00

Feb-$119.00       Mar-$102.00     Apr-$85.00         May-$68.00

June-$51.00       July-$34.00       Aug-$17.00

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Any questions, please contact us here.