Provider Member Application

Home / Membership / Become a Provider Member  / Provider Member Application

Thank you for your interest in joining the LeadingAge PA community!

Please complete the membership application form below, and a team member will be in touch with you shortly.

 

Organization Information

Organization Status

Affiliation (if applicable):

Service Types

Check all that apply to this organization

Other Services Available

Membership Dues Calculations

LeadingAge PA and LeadingAge National dues are calculated based on annual Program Service Revenue (PSR)* that is collected by an organization at the site level. There are also Special Program categories that are not assessed dues based on PSR (e.g. Subsidized Housing). 

*Program Service Revenue is defined as the revenue an organization receives from aging services activities that are “primarily those that form the basis for an organization’s exemption from tax." It EXCLUDES unrelated items such as interest, realized and unrealized gains or losses, special events/activities, charitable contributions, and other unrelated services.

The PSR should come from IRS Form 990, Part I, Line 9 of the most recently completed fiscal year.

 Need Assistance? Contact Membership@LeadingAgePA.org