Assisted Living Provider Membership Application
  • CEO and/or Manager (Main Point of Contact)

  • Billing Contact (if different from main contact above)

  • Community Composition

  • # Total Employees
  • Please enter a number greater than or equal to 11.
  • Price: $0.00
  • $0.00

*Dues payments to Arizona ALFA are not tax deductible as charitable contributions  for federal income tax purposes. Contributions or gifts to Arizona ALFA may be tax-­‐deductible as ordinary and necessary business expenses (27% of dues fee is non-­deductible as lobbying expenses).

Arizona ALFA Membership Guidelines

Each member subscribes to the following guidelines as set forth by the Arizona


Through submitting this application you agree to the following:

  • The member maintains Worker Compensation as required by law;
  • The member maintains professional liability insurance;
  • The member follows a non-­‐discrimination policy in the hiring of employees and the admission of residents as required by law.

As required by Arizona State Statute and Rules…

  • The member subscribes to continuing education and training of its employees to better serve residents;
  • The member conducts employment reference checks on its employees prior to employment;
  • The member will ensure that each direct care employee is properly fingerprinted;
  • The member will create a written service plan for each resident stating the level of care to be provided;
  • The member operates the home/center in a fiscally responsible manner;
  • The property maintains and displays a valid operating license issued from the Office of Assisted Living Licensure, Department of Health Services, and State of Arizona.