Membership Application Form

To become a member, or renew your membership, or add additional sites, please complete the following form. This information will be used in the Association's website and membership mailings. Those affiliated with a licensed Center must take a Center membership.  Individuals and companies interested in adult day services who do not operate a licensed center are welcome to join as an Allied Professional.  You may pay online at a secure web site by clicking on the apporpriate option below the form.

Membership Applications Form

Check One: New Member Renewing Member
  Center Allied Professional  
Annual $300 $125    

Center Info:

 

 

Name:
Position:
Agency:
Center name:
Address: Address 2:
City: State: Zip:
County:
PADSA Region Selection:
Business Phone:
Fax:
E-Mail:
Web Site:

New provider member applicants, please submit a copy of your license and an agency brochure with a check made payable to PADSA. Please send both to:
Pennsylvania Adult Day Services Association
P. O. Box 273
Lionville, Pa 19353
877-89padsa (877-897-2372
www.padsa.org / E-Mail info@padsa.org

If you would like a hard copy of the form to fill out, please click here.

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