Business Member Application

Name of Firm:*
Primary Contact/Representative:*
First Last
Primary Contact/Representative Title:*
Primary Contact/Representative Email:*
Additional Representatives
Additional Representative One Name:
First Last
Additional Representative One Title:
Additional Representative One Email:
Additional Representative Two Name:
First Last
Additional Representative Two Title:
Additional Representative Two Email:
Additional Representative Three Name:
First Last
Additional Representative Three Title:
Additional Representative Three Email:
Address For Directory:*
Street Address Address Line 2 City State ZIP Code
Is Mailing Address different than Directory Address
- yes
Mailing Address:*
Street Address Address Line 2 City State ZIP Code
Phone:*
Fax:
Website
Please select (2-3) categories that most correspond to your services/products (LIMIT 3):
- Accounting / Payroll
- Advertising / PR
- Architecture / Design
- Clinical Care
- Compliance Resource
- Construction/Engineering
- Consulting
- Diagnostics
- Education
- Emergency Preparedness
- Employee Benefit Services
- Entertainment
- Environmental Services
- Equipment
- Financial Services
- Flooring
- Food Service
- Furnishings
- General Contracting/Building
- Heating, Ventilation and AC (HVAC)
- Home Care
- Housekeeping/Linens/Laundry
- Institutional Pharmacy
- Insurance
- Interior Design
- Laboratory Services
- Legal Services
- Life Safety Solutions
- Linen Services
- Marketing
- Medical Supplies
- Pharmaceutical
- Physician/Nurse Practitioners
- Purchasing Programs
- Reimbursement
- Retirement Planning
- Risk Management
- Salon / Spa Services
- Senior Transition Specialists
- Staff / Recruiting
- Sustainability
- Technology/Computer/Software
- Telecommunications
- Therapy / Rehabilitation
- Transportation
- Wound Care
- X-Ray Services
- Other
Other Category:
Please tell us about your company for our Directory:
Is your firm part of a larger corporate structure?
- yes
What is the name of the parent organization?
What services / products does it provide, and to whom?
Does the parent corporation or any of its subsidiaries operate nursing homes, facilities, agencies or institutions for the aging?
- yes
in what states?
How did you learn about LeadingAge Washington?
Membership Options*
- Diamond $10,500
- Ruby $8,000
- Sapphire $5,500
- Emerald $3,000
- Pearl $1,250
- Opal $650
Your Name:*
First Last
Membership Renewal: Membership is automatically renewed each year. Notification of changes regarding level or changes in options must be received by 12/31*
- I understand
Please make checks payable to LeadingAge Washington, 1102 Broadway, Ste 201, Tacoma, WA 98402. If you have any questions or issues submitting this form, please contact Cassi at cmeritt@leadingagewa.org. Thank you for your interest.

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InsPAC2025 Webinar Series: Regulatory Compliance Bootcamp

Expert-Led Sessions by Interdisciplinary Professionals LeadingAge Washington is pleased to offer this monthly training series. Institute of Post-Acute Care (InsPAC) will bring esteemed healthcare leaders, including Chief Nursing Officer, Administrators, Directors of Nursing, Infection Preventionist, Wound Care Specialists, Therapists, Nurse Aides, and Mental Health Expert to this new webinar series. Let their experts provide you… Read More

InsPAC2025 Webinar Series: Advanced Quality Assurance and Performance Improvement (QAPI)

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