Franchise Membership Application

Franchise Membership Application

A “Franchise Member” is defined as an organization with licensed home & community support service agencies (HCSSA) granted the right to use its trademark or trade name.

A Franchise’s number of licensed HCSSA’s committed to TAHC&H membership determines the annual dues amount.
Franchise Name *

Primary Contact Address *

Street Address
Street Address Line 2
City, State Zip	State Zip
Postal / Zip Code	Country

CEO/Authorized Representative *

First Name Last Name
Voting Representative at Association Business Meetings *

First Name Last Name
Primary Contact Direct Phone Line *

Area Code Phone Number
Primary Contact/ Communications To *

First Name Last Name
Primary Contact Email *
Primary Contact Cell Phone

Area Code Phone Number
Website Address
Additional Information
Home Care Defense Fund

The TAHC&H Home Care Defense Fund (HCDF) supports industry efforts to advance legislation through lobbying and public relations. Donations allow TAHC&H to go above and beyond the fight for home care and hospice. Your additional support is critical for shaping the future of our industry! Corporate funds allowed.
Would you like to donate to the Home Care & Hospice Defense Fund? *

Yes No
How much would you like to contribute to the Home Care & Hospice Defense Fund?*
Regarding Membership

Conditions of Membership Participation:
1. Membership benefits begin with receipt of payment and continue for one year. Only employees of the member entity may utilize member benefits.
2. Franchise Provider Membership in TAHC&H is open to licensed home & community support services agencies only.
3. Adherence to TAHC&H Code of Conduct .
4. Dues are based on the # of participating licensed parents. Franchise owners and their employees who choose not participate (join) do not have TAHC&H member privileges.
5. Franchisees choosing not to participate at the time of the initial join or renewal date may join at a pro-rated rate of the standard provider dues and receive the franchise membership rate at the time of renewal for the entire group.
6. Membership dues, administration fees (if applicable) and voluntary contributions are non-refundable.
7. TAHC&H member dues are an allowable expense for Medicare and Medicaid. Contributions or gifts to TAHC&H are not tax deductible as charitable contributions for income tax purposes.**
Check Dues Category for # of Franchisees joining (divide the total by the # of participants for a per location breakdown): *

1 Franchise ($1638) 2 Franchises ($2185) 3-4 Franchises (3824) 5-7 Franchises ($4917) 8-10 Franchises ($6010) 11-14 Franchises ($7102) 15-20 Franchises ($8195) 21-30 Franchises ($10,381) 31-40 Franchises ($12,566) 41-50 Franchises ($16,188) 51+ Franchises ($18,030)
We will...

Email a list of franchisees joining to membership@tahch.org Contact TAHC&H at (800) 880-8893 and provide the list
When contacted by TAHC&H:

I wish to charge the amount for membership to the credit card given.
Acknowledgement *

I have read and acknowledge the information above regarding my membership
Signature *
+ If each franchisee is paying their portion of the dues, membership for the entire group will not be processed until dues from all participating franchisees is received in the TAHC&H office. Owners of more than one franchise must join each license they own/operate. Membership is limited to the franchisees who are verified participants only. Payment plan is not available to Franchise membership. Read TAHC&H Bylaws regarding Franchise membership.

* Home Care Defense Fund contributions are not tax deductible since all funds are allocated to lobbying activities.

**TAHC&H estimates that the non-deductible portion of your dues allowable to lobbying for 2019 is 25%.
Call TAHC&H at (800) 880-8893 for additional information.

Membership Stronger
Should be Empty:

Additional Information