WHCA/WiCAL Partnership Application

Partnership Level*

Please select one option from the drop-down.

Areas of Interest or Participation*

Please select the areas in which you support and/or wish to become involved with.

Assisted Living Events

Skilled Nursing Events

Exhibitor Opportunities

Sponsorship Opportunities

Scholarships for Members

Education & Training

Speaking Opportunities

Advocacy & Political Action

Other

IF you selected "Other" please explain below

Billing Contact

WHCA/WiCAL will use this information for dues/event/sponsorship invoicing and collection purposes.

Billing Contact Name*

First Last

Billing Contact Phone*

Billing Contact Email*

Event Contact

Does your company have an events team or contact person? If so, please provide their information below.

Event Contact Name

First Last

Event Contact Email

Applicant Name*

First Last

Applicant Email*

How did you hear about WHCA/WiCAL?

Prior conversations with Jena or association staff about Partnership

Social Media or Web Search

Participated at Spring Conference as a non-Partner

Prior Partnership with WHCA/WiCAL

Referral from a partner or member

Other

In consideration of the services provided by WHCA/WiCAL, submission of this application constitutes your agreement to abide by the articles and bylaws of WHCA/WiCAL as now in existence or hereafter amended. Your partnership will be effective the date payment is received in full by WHCA/WiCAL. Partnerships automatically renew each calendar year. If you selected to pay via check, you will be promptly invoiced for the total amount due for partnership. Payment of partnership dues must be completed/received within 15 business days or the partnership application will be cancelled.

Total

Payment Type:*

Credit Card

Check

Credit Card

Company Information

Billing Contact

Event Contact