Membership Application .Membership Application If you would like to be considered for membership in LCA (Leadership Coalition on Aging), here are the eligibility criteria. CRITERIA FOR MEMBERSHIP IN LCA To remain in good standing, each member agency/organization is obligated to: Participate in the annual conference as a sponsor, expo vendor or attendee Participate in an active committee Participate in a minimum of one (1) empowerment series event Organizations eligible for membership are: Non-profit organizations, 501(c)(3) tax-exempt organizations or municipal, state and federal government agencies that provide social, educational, or health and human services that benefit seniors and/or caregivers in Collier County For-profit organizations that provide social, educational or health and human services that benefit seniors and/or caregivers in Collier County. Would you like to be considered for LCA Membership? * Yes No If you would like to be considered, your application will be reviewed by the LCA membership committee. Application Form Name of Organization Address City State AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip/Postal Code Phone Fax Website Enter entire URL (include the http://) Facebook Page Enter entire URL (include the http://) Contact Name Contact Phone Alternate Contact Alternate Contact Phone Primary Email Alternate Email Type of Organization * For-Profit Non-Profit Select One Select Appropriate Search Categories for Your Organization Case Management Counseling Services Employment Resources Financial & Legal Services Food Assistance, Nutrition & Lunch Health Care Resources Home Care Resources Hotlines Housing LCA Member Organization Shelters Transportation Utilities Miscellaneous Select all that apply Description of Services Enter description as you would like it to appear on the CSR Website. (Maximum of 100 Words) Services/Programs Offered Include up to 3 primary services/programs Second Service/Program Third Service/Program Available for Speaker's Bureau? Yes Provide Topics for Presentation * Upload Your Agency/Organization Logo Drop a file here or click to upload Choose File Maximum upload size: 5MB Indicate Preference of Membership in LCA Workgroups Public Relations & Advocacy Membership Senior Empowerment Series Conference on Aging Gift a Bed Here for Seniors & Caregivers info@lcacollier.org | 4898 Coronado Pkwy. Naples, FL 34116
