Membership Renewal: Copy & Paste to a Word document, or right click & print, complete and email or mail to MaryBeth Smaha @ mbsmaha@gatewayscs.com
ADULT DAY SERVICES OF NEW HAMPSHIRE
Please join our organization or continue your membership.
BENEFITS OF MEMBERSHIP INCLUDE:
� Interaction w/ other Adult Day Providers and supporters through meetings and conferences.
� E-Mailings and other communications impacting the industry of Adult Day Providers on a state and national level.
� Listing of your program on the Adult Day Services Association website & brochure.
� Advocacy on the state level for Adult Day Program.
MEMBERSHIP DUES FOR THE TERM 2011/2012
Membership Fee: $90.00: Organization/Vendor/Agency
$25.00: Student/Caregiver
Organization: __________________________________________________
Name: _________________________________________________________
Representative(s): ________________________________________________
Address: ________________________________________________________
City: __________________________State: ______________Zip:___________
Email: __________________________________________________________
Telephone: _______________________________________________________
Fax: _____________________________________________________________
Website: _________________________________________________________
Make Check payable to: Adult Day Services of New Hampshire
Send form & checks to: Gateways Community Services
Or bring to meeting!! Alvirne Voc Tech Center
200 Derry Rd.
Hudson, NH 03051
Attn: Mary Beth Smaha